WHAT IS LIVER BIOPSY?

The liver is a vital organ crucial to the body’s functions. It is also considered the second largest gland of the body, with incredible duties performed.

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Due to its vast activities and first line of action against infection and foreign invaders, there is a huge possibility of becoming at risk of its health.

So sometimes, doctors need to take a closer look at it to diagnose and treat certain liver problems to achieve accurate and complete diagnosis.

It is a specialized technique in which a minute portion of liver tissue is surgically removed and examined under a microscope. This procedure is called a liver biopsy.

"Liver Biopsy: A Crucial Diagnostic Tool in Hepatology"

This article will explain what a liver biopsy is, why it’s done, and what you can expect during the process.

WHY IS LIVER BIOPSY NEEDED?

· It is required when the imaginary tools and blood samples cannot clarify the nature of the disease.

· Imaginary tools like CT scans show certain abnormalities in the anatomy of liver tissues.

· To keep surveillance of the liver after the liver transplant surgery.

· To determine the severity of the hepatic disorder.

· To give the grading or staging of the disease.

· To check the effectiveness of continued treatment for the disease.

· Idiopathic splenomegaly or hepatomegaly.

WHAT ARE THE MEDICAL CONDITIONS IN WHICH THE LIVER BIOPSY IS MANDATORY?

These include:

· Unsure jaundice.

· Chronic Hepatitis (A and C).

· Alcoholic liver disease.

· Non-alcoholic fatty liver disease.

· Suspicious liver tumor.

· Metabolic or autoimmune hepatitis.

· Hemochromatosis.

· Liver cirrhosis.

· Primary biliary cholangitis.

· Wilson disease.

· Hodgkin lymphoma.

· Hepatocellular Carcinoma.

WHAT ARE PRE-BIOPSY PREPARATION STEPS?

· A meeting is conducted between the patient and the healthcare provider to discuss everything regarding the procedure, and the patient should ask questions which are in your mind regarding the procedure.

· A consent form must be signed before the procedure. The patient reads it carefully and asks a question if something needs to be clarified.

· The doctor requires a complete picture of the patient pre-procedure health and a complete list of medications that the patient took. With the doctor’s advice, the patient will stop all blood-thinning medications like aspirin, ibuprofen, and warfarin and stop using dietary supplements, which enhance the blood-thinning process.

· The doctor does a complete physical examination. Before the liver biopsy, the patient’s overall health is good as well, and some necessary blood tests are required before the surgery.

· Tell your doctor if you are sensitive/allergic to certain medications.

· The patient must give complete information regarding their medication and its complete prescription.

· Tell the doctor about your pregnancy (if you are) or plan to be pregnant.

· The doctor will temporarily stop the medication you are using before the biopsy.

· It is recommended to stop eating or sometimes drinking 6 to 8 hours before liver biopsy.

· The patient will receive a sedative before the procedure to remain relaxed and comfortable during the procedure.

Percutaneous Liver Biopsy:

In the case of a percutaneous liver biopsy, the doctor will be asked to lie on the back and rest the right hand just above the head on the table.

The doctor will make a small incision on the right side of the abdomen and insert the biopsy needle.

Transjugular liver biopsy:

The Transjugular liver biopsy is also a technique in which the doctor will ask you to lie on your back and then apply local anesthesia exactly where the jugular vein was found with the help of fluoroscopy. Then, the doctor will insert a biopsy needle.

Laparoscopic liver biopsy:

In a surgical liver biopsy, the patient is placed in a supine position on the table under general anesthesia.

WHAT ARE THE TYPES OF LIVER BIOPSY?

1. Percutaneous Liver Biopsy:

It is the most common type. Doctors use local anesthesia; usually, lidocaine is used along with a special needle to take a tiny piece of the liver directly through the abdomen skin. It is considered the least invasive technique, which is most commonly used. It is used to diagnose liver diseases like hepatitis or cirrhosis.

2. Transjugular Liver Biopsy:

Transjugular liver biopsy is used when the patient suffers from a bleeding disorder or has huge Ascite (fluid accumulation in the abdomen). In this type of liver biopsy, local anesthesia is given, and an incision is made in the vein of the neck (jugular vein). A thin tube is inserted into the vein, reaching the liver. The tissue sample is collected through this tube.

3. Laparoscopic Liver Biopsy:

Laparoscopic liver biopsy is also known as surgical biopsy. In this method, general anesthesia is used. It involves a small keyhole size incision, and a thin light tube is inserted along with a camera (laparoscope) to guide the biopsy. Another tube is used if the tissue sample is needed to collect. Doctors might use this when they need a more detailed look at the liver.

HOW HEALTHCARE PROVIDER STARTS THE LIVER BIOPSY PROCEDURE?

· Patients get sedative medicine to keep them relaxed or sleep.

· The doctor will use the chosen method (percutaneous, transjugular, or laparoscopic) depending upon the cause and severity of the disease, examine the complete picture of the liver, and extract a tissue sample of the liver.

· It doesn’t take too long, usually about 15-30 minutes.

WHAT ARE THE POSSIBLE RISK FACTORS/ COMPLICATIONS?

Although the liver biopsy is a safe procedure done by expert healthcare providers, there is some risk factor associated with the procedure:

· General feeling of discomfort/Pain:

It is a quite common condition experienced by the patient. Pain or discomfort just after the liver biopsy is not very severe, so doctors usually suggest painkillers like acetaminophen. Sometimes, depending upon the patient’s condition, a combination with little narcotics will be prescribed to ease discomfort.

· Heamhorrhage:

It is also a complication of the procedure, but usually it is not common. Bleeding from the site of tissue extraction sometimes requires surgery to overcome the problem.

· Infection:

Coincidently, bacterial infection can occur at the procedure site and cause infection.

· Injury to closely located organs:

In rare cases, liver biopsy needles accidentally hit nearby organs like the gallbladder and cause injury.

· Hypotension:

Some patients experience low blood pressure along with light-headedness after the liver biopsy. It is a temporary condition and soon go away.

WHAT ARE THE POST-BIOPSY CARE MEASURES?

· Just after the procedure is completed, the patient will be monitored for a while, with a strict eye on the vital signs and stability.

· The doctor will recommend resting at least 2 to 4 hours, depending on the type of biopsy done. Additional 24-hour bed rest is also advisable.

· Taking a CBC sample a few hours after the liver biopsy to check the internal blood loss.

· If there can be some side effects or complications, like pain or bleeding, they’ll watch out for those.

· Ensure the bandage is intact as instructed; usually, 1 to 2 days is recommended.

· A liver biopsy causes some discomfort for the next few days, so using sedatives and painkillers is beneficial.

· You can return to your normal activities after a day.

· You’ll have follow-up appointments to discuss the results.

· Consult the doctor if the patient experiences chills, fever, bleeding, redness, swelling, or shortness of breath.

HOW LONG DOES A LIVER BIOPSY TAKE?

1. Percutaneous Liver Biopsy: 15 to 30 minutes.

2. Transjugular Liver Biopsy: 30 to 60 minutes.

3. Laparoscopic Liver Biopsy: 15 to 20 minutes.

WHAT ARE THE ALTERNATIVES TO LIVER BIOPSY?

Although liver biopsy is considered an ideal diagnostic tool for liver disorders, it has some major drawbacks, including being invasive, the chances of complications, and misinterpreting disease severity due to false-negative results. So, there is always a need for some non-invasive alternative that overcomes all these aspects.

So here is a list of some non-invasive alternatives concerning liver biopsy, which includes

· Quantitative laparoscopic liver spleen scan (QLSS) (helpful in functional staging and fibrosis diagnosis).

· Multiphasic MRI (help in finding different types of liver lesions).

· Fibrotest (a special biomarker that uses 6 blood serum tests, proposes a score, and is used to correlate to the degree of liver damage).

· Fibroscan (type of ultrasound used transient elastography helps to calculate liver stiffness). The combination of the above two sometimes would replace liver biopsy.

Some other biomarkers include:

· Hyaluronic Acid (HA) is a compound produced in the stellatae cells of the liver, and its clearance is also through the liver within minutes. Only a small ratio is being eliminated through the renal pathway. In healthy liver hepatocytes, its concentration is normal; in the fibrotic or cirrhotic liver, the concentration is increased up to 2 folds.

· Laminin (elevated in fibrotic liver disorders).

· Alpha-2-macroglobulin (A2M) is an important indication for fibrosis, a proteinase synthesized in the hepatocyte.

· Type-IV collagen(CL4) sensitive marker for increased levels of type-iv collagen and its active deposition in the liver tissues (active fibrosis).

CONCLUSION:

In summary, a liver biopsy is a procedure that helps doctors understand your liver’s condition. It’s crucial for diagnosing and treating liver diseases. If your doctor suggests a liver biopsy, don’t feel ashamed to ask questions and discuss your concerns with your healthcare provider. It’s all part of personalized medicine and ensuring the best care for your health.

“Liver Biopsy”: A Crucial Diagnostic Tool in Hepatology.