Makindo Medical Notes

📖 About

• A liver biopsy provides essential information on the liver's structure, degree of inflammation, fibrosis, or other pathology, aiding diagnosis and guiding management.
• Performed under radiologic guidance in most cases to enhance accuracy and reduce risks.
• Patient cooperation (especially breath-holding) is essential for a safe percutaneous biopsy.
• ⚠️ Avoid biopsy of surgically resectable malignancies due to the risk of tumour seeding and bleeding.

🎯 Indications for Liver Biopsy

• Diagnosis & Staging: Identifies cause of liver disease and assesses fibrosis.
• Persistently Abnormal LFTs: When no clear cause is found.
• Chronic Liver Disease: Hepatitis, autoimmune hepatitis, NASH, PBC, PSC.
• Drug-Induced Liver Injury (DILI): Assessment of medication-related hepatotoxicity.
• Suspected Liver Tumours: Confirms diagnosis when imaging is inconclusive.
• Inherited Disorders: e.g., haemochromatosis, Wilson’s disease.
• Transplant Work-Up: Fibrosis staging and transplant suitability.

⚠️ Risks of Liver Biopsy

• Bleeding: 0.6–1% of cases; significant bleeding ~3/1000.
• Bile Peritonitis: Rare (1/1000).
• Pain: Most common complication; usually mild.
• Infection: Rare, but potentially serious.
• Injury to Nearby Organs: e.g., lung or kidney puncture.

🧪 Pre-Procedure Requirements

• Bloods: FBC, PT, PTT; correct coagulopathy with FFP/Vit K.
• Imaging: Pre-procedure ultrasound to assess anatomy/ascites.
• Consent: Explain risks, benefits, and alternatives.

🔬 Types of Liver Biopsy

Type	Description	Indications
Percutaneous	Needle through right intercostal space, usually with US guidance.	Standard approach if no ascites or coagulopathy.
Ultrasound-Guided	Real-time US improves accuracy, esp. in obesity or difficult anatomy.	Preferred in atypical anatomy or obesity.
Transjugular	Catheter via jugular vein into hepatic veins; avoids liver capsule puncture.	✅ Coagulopathy, ✅ ascites, ✅ portal pressure measurement.

🚫 Contraindications

• Absolute: Uncooperative patient, uncorrectable coagulopathy, severe ascites, extrahepatic obstruction.
• Relative: Obesity, hemangioma, previous surgery, local infection.

🩺 Post-Procedure Care

• Monitor 2–4 hours (vitals, pain, signs of bleeding).
• Rest 24–48 hrs; avoid heavy activity.
• Look for ⚠️ right shoulder pain (may indicate bleeding).
• Red flags to warn patient: abdominal pain, dizziness, breathlessness.

🔍 Common Findings

• Fibrosis/Cirrhosis: Grading severity.
• Steatosis: NASH, alcoholic liver disease.
• Hepatitis: Viral, autoimmune, drug-related.
• Granulomas: TB, sarcoidosis, PBC.
• Tumours: Distinguish benign vs malignant.

📊 Interpretation

• Histopathology: Inflammation, necrosis, fibrosis, architecture.
• Scoring Systems: METAVIR, Ishak scores quantify fibrosis.

🕑 Results usually take a few days. Ensure clear follow-up for results and management planning with the clinical team.