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 |  موضوع: Liver biopsy  الإثنين يناير 03, 2011 11:47 am | |
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What is a liver biopsy
A liver biopsy is a
procedure to remove a small piece of the liver so it can be examined
with a microscope for signs of damage or disease. The three main types
of liver biopsy are percutaneous, transvenous, and laparoscopic
When is a liver biopsy performed
A
liver biopsy is performed when a liver problem is difficult to diagnose
with blood tests or imaging techniques, such as ultrasound and x ray
More
often, a liver biopsy is performed to estimate the degree of liver
damage—a process called staging. Staging helps guide treatment
How does a person prepare for a liver biopsy
At
least 1 week before a scheduled liver biopsy, patients should inform
their doctor of all medications they are taking. Patients may be asked
to temporarily stop taking medications that affect blood clotting or
interact with sedatives, which are sometimes given during a liver biopsy
Medications that may be restricted before and after a liver biopsy include
nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen
blood thinners
high blood pressure medication
diabetes medications
antidepressants
antibiotics
asthma medications
dietary supplements
Prior
to liver biopsy, blood will be drawn to determine its ability to clot.
People with severe liver disease often have blood clotting problems
that can increase the risk of bleeding after the procedure. A medicine
given just before a liver biopsy, called clotting factor concentrates,
reduces the risk of bleeding in patients with blood clotting
abnormalities
Patients who will be sedated should not eat or
drink for 8 hours before the liver biopsy and should arrange a ride
home, as driving is prohibited for 12 hours after the procedure. Mild
sedation is sometimes used during liver biopsy to help patients stay
relaxed. Sedatives are often given through an intravenous (IV) tube
placed in a vein. The IV can also be used to give pain medication, if
necessary, after the procedure
How is a liver biopsy performed
All
three main types of liver biopsy remove liver tissue with a needle;
however, each takes a different approach to needle insertion. A liver
biopsy may be performed at a hospital or outpatient center
Percutaneous Liver Biopsy
The
most commonly used technique for collecting a liver sample is
percutaneous liver biopsy. For this method, a hollow needle is inserted
through the abdomen into the liver to remove a small piece of tissue
During
the procedure, patients lie on their back on a table with their right
hand resting above their head. A local anesthetic is applied to the
area where the biopsy needle will be inserted. If needed, an IV tube is
used to give sedatives and pain medication
The doctor makes a
small incision in the abdomen, either toward the bottom of the rib cage
or just below it, and inserts the biopsy needle. Patients will be asked
to exhale and hold their breath while the needle is inserted and a
liver sample is quickly withdrawn. Several samples may be collected,
requiring multiple needle insertions
After the biopsy, patients
must lie on their right side for up to 2 hours to reduce the risk of
bleeding. Patients are then monitored an additional 2 to 4 hours after
the biopsy before being sent home
Transvenous Liver Biopsy
Transvenous
liver biopsy is used when a person’s blood clots slowly or when excess
fl uid is present in the abdomen, a condition called ascites
During
the procedure, patients lie on their back on an x-ray table and a local
anesthetic is applied to one side of the neck. If needed, an IV tube is
used to give sedatives and pain medication
A small incision is
made in the neck and a specially designed hollow tube called a sheath
is inserted into the jugular vein. The doctor threads the sheath down
the jugular vein, along the side of the heart, and into one of the
hepatic veins, which are located in the liver. To see the veins, the
doctor injects liquid contrast material into the sheath. The contrast
material lights up when x rayed, highlighting the blood vessels and
showing the location of the sheath
The doctor threads a biopsy
needle through the sheath and into the liver and a liver sample is
quickly withdrawn. Several samples may be collected, requiring multiple
needle insertions. The sheath is carefully withdrawn and the incision
is closed with a bandage
Patients are monitored for 4 to 6 hours for signs of bleeding
Laparoscopic Liver
Biopsy
Doctors
use laparoscopic liver biopsy to obtain a tissue sample from a specific
area or from multiple areas of the liver or when the risk of spreading
cancer or infection exists
Laparoscopic surgery is a technique
that avoids making a large incision by instead making one or a few
small incisions. The doctor works with special tools—including a small,
lighted video camera—passed through the incisions
A doctor may take a liver sample during laparoscopic surgery performed for other reasons, including liver surgery
During
laparoscopy, patients lie on their back on an operating table. An IV is
inserted in a vein to give sedatives and pain medication. A small
incision is made in the abdomen, usually just below the rib cage. A
plastic, tubelike instrument, called a cannula, is inserted in the
incision and the abdomen is inflated with gas. Inflation allows the
doctor space to work inside the abdominal cavity
A biopsy needle
is inserted through the cannula and into the abdomen. The needle is
inserted into the liver and a tissue sample is quickly withdrawn.
Several samples may be collected, requiring multiple needle insertions.
Any excessive bleeding because of the surgery is easily spotted with
the camera and treated using an electric probe
After liver samples are collected, the cannula is removed and the incision is closed with dissolvable stitches
Patients will need to remain at the hospital or outpatient center for a few hours while the sedatives wear off
Points to Remember
A
liver biopsy is a procedure to remove a small piece of the liver so it
can be examined with a microscope for signs of damage or disease
The three main types of liver biopsy are percutaneous, transvenous, and laparoscopic
A liver biopsy is used to diagnose liver problems or to estimate the degree of liver damage
Patients
prepare for a liver biopsy by stopping medications that might interfere
with blood clotting and by having blood drawn to make sure clotting is
normal. Patients who will be sedated should not eat or drink for 8
hours before the liver biopsy and should arrange a ride home
All
three main types of liver biopsy remove liver tissue with a needle;
however, each uses a different approach to inserting the needle into
the liver
Results from a liver biopsy take a few days to come back
Most patients fully recover from a liver biopsy in 1 to 2 days
The major risk of liver biopsy is excessive bleeding, called hemorrhage
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