- Liver biopsy
Liver biopsy is the
biopsy(removal of a small sample of tissue) from the liver. It is a medical testthat is done to aid diagnosisof liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment.cite journal |author=Grant A, Neuberger J |title=Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology |journal=Gut |volume=45 Suppl 4 |issue= |pages=IV1–IV11 |year=1999 |month=October |pmid=10485854 |pmc=1766696 |doi= |url=http://gut.bmj.com/cgi/content/full/45/suppl_4/IV1]
Liver biopsies may be taken
percutaneously (via a needle through the skin), transvenously (through the blood vessels) or directly during abdominal surgery. The sample is examined by microscope, and may be processed further by immunohistochemistry, determination of ironand coppercontent, and microbiological cultureif tuberculosisis suspected.
Liver biopsy is often required for the diagnosis of a liver problem (
jaundice, abnormal blood tests) where blood tests, such as hepatitis Aserology, have not been able to identify a cause. It is also required if hepatitis is possibly the result of medication, but the exact nature of the reaction is unclear. Alcoholic liver diseaseand tuberculosis of the liver may be diagnosed through biopsy. Direct biopsy of tumors of the liver may aid the diagnosis, although this may be avoided if the source is clear (e.g. spread from previously known colorectal cancer).
If the diagnosis is already clear, such as chronic
hepatitis Bor hepatitis C, liver biopsy is useful to assess the severity of the associated liver damage. The same is true for haemochromatosis(iron overload), although it is frequently omitted. Primary biliary cirrhosisand primary sclerosing cholangitismay require biopsy, although other diagnostic modalities have made this less necessary.
Occasionally, liver biopsy is required to monitor the progress of treatment, such as in chronic viral hepatitis. Liver biopsies can also be done during
weight loss surgery, to look for non-alcoholic fatty liver disease.
While liver biopsy is generally a safe procedure, there is a small risk of complications, especially bleeding. Several precautions need to be taken, and particular situations (such as high bleeding risk) can partially or completely prohibit liver biopsy. Care must be taken not to puncture other organs such as the
lung(above the liver), the diaphragm, or the intestines.
The first liver aspirate was performed by the German physician
Paul Ehrlichin 1883. Percutaneous liver biopsy was first reported in the 1920s. The transjugular approach was pioneered by radiologist Charles Dotterin the 1970s. [cite journal |author=Rösch J, Lakin PC, Antonovic R, Dotter CT |title=Transjugular approach to liver biopsy and transhepatic cholangiography |journal=N. Engl. J. Med. |volume=289 |issue=5 |pages=227–31 |year=1973 |month=August |pmid=4713761]
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