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A liver biopsy can
usually be safely performed as an outpatient procedure. A physician
trained and experienced in the procedure should perform the liver
biopsy. Prior to the procedure, patients should discontinue all
anticoagulants (e.g., coumadin) for at least a week and should not take
aspirin or other non-steroidal anti-inflammatory medicines for about a
week (patients can take acetaminophen). Additional contraindications to
percutaneous liver biopsy include the following:
Absolute
Contraindications
-Uncooperative patient
-History of unexplained
-bleedingTendency to bleed*
-Prothrombin time 3-5 sec more than control
-Platelet count <50,000/mm3
-Prolonged bleeding time (10 minutes)
-Use of NSAID within previous 7-10 days
-Blood for Transfusion unavailable
-Suspected hemangioma or other vascular tumor
-Inability to identify an appropriate site for biopsy by percussion or
ultrasonography
-Suspected echinococcal cysts in the liver
Relative
Contraindications
-Morbid obesity
-Ascites
-Hemophilia
-Infection in the right pleural cavity or below the right hemidiaphragm
*Although these
criteria are considered absolute contra-indications by most
hepatologists, they can be corrected by transfusions of platelets or
fresh-frozen plasma and are therefore not truly absolute.
SOURCE: Bravo AA,
Sheth SG, Chopra S. Current Concepts: Liver Biopsy. N Engl J Medicine
2001; 344: 498, Table 2.; Use of aspirin within 7-10 days is an absolute
contraindication to liver biopsy. Use of other NSAIDS within the
previous 3 days is generally an absolute contraindication.
For the procedure:
Patients must provide
written informed consent.
Patients are placed flat in bed and the liver is localized in the right
mid-axillary line. Localization of the liver can be performed by
percussion/palpation or by ultrasound. Some physicians administer
conscious sedation prior to the liver biopsy.
The skin over the biopsy site is cleaned with betadine or another
suitable antiseptic, and lidocaine is injected locally to anesthetize
the skin and the capsule of the liver.
Liver biopsy is performed by quickly inserting and then withdrawing a 15
to 18-gauge needle into the liver. A successful biopsy obtains a piece
of liver tissue approximately the diameter of the lead in a pencil and 1
inch long
Post-Procedure:
-The patient lies on
his/her right side for 1-2 hours and then on his/her back for 3-5 hours
(total observation after liver biopsy is 4-6 hours)
-Blood pressure and heart
rate are checked frequently during this time
-Patients are allowed to
go home if they can follow instructions reliably and have easy access to
a hospital should they develop bleeding or other complications
-Patients should remain
off anti-coagulants, aspirin and NSAIDs for at least one week
-Patients should be
advised to refrain from heavy lifting or strenuous exercise for one to
two weeks following the procedure
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