Percutaneous Liver Biopsy in New Orleans, LA
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What is a liver biopsy?
A liver biopsy is a procedure to collect a small piece of liver tissue so that it can be analyzed. Liver biopsies may be required to determine the extent of injury from a preexisting disease or to determine a diagnosis for an unknown condition. Providers use liver biopsies as an essential piece of the puzzle in the determination of how to best meet your individualized needs. Generally, liver biopsies are performed through the skin, or percutaneously, which allows the individual to return home within 2 – 4 hours of the procedure taking place. If your provider determines that a percutaneous approach to your liver biopsy is not an option, there are other methods of obtaining the liver tissue sample as well. Anxiety is common when being scheduled for a biopsy since the word "biopsy" is commonly connected with the concern of cancer and the general fear of a painful extraction. Rest assured that the technique used for percutaneous liver biopsies is extremely safe and has been used since the 1950s. Our skilled Metropolitan Gastroenterology Associates gastroenterologists will strive to ensure your comfort during your liver biopsy. To find a GI specialist who performs percutaneous liver biopsies in New Orleans, LA, contact a location near you today.
Why is a liver biopsy performed?
Liver biopsies are most often performed by gastroenterologists, radiologists, hepatologists, and sometimes by surgeons. Generally, liver biopsies are only performed if the results will assist in treatment planning. Some examples of when they may be required include:
- Monitor the liver after a liver transplant
- Investigate abnormal liver function tests (blood tests that show liver damage) or diagnose unexplained liver disease
- Assess the severity of injury caused by various types of liver diseases including:
- Primary sclerosing cholangitis
- Chronic hepatitis B or C
- Primary biliary cirrhosis
- Autoimmune hepatitis
- Nonalcoholic steatohepatitis (NASH)
- Hemochromatosis or Wilson’s disease
Your Metropolitan Gastroenterology Associates provider might also request a liver biopsy if you have certain rare metabolic diseases, are experiencing unexplained fevers, or have other rare disorders where they feel a liver biopsy might be helpful.
A liver biopsy can be dangerous or unsafe to perform under certain circumstances. Most commonly, these conditions include patients with:
- Severely anemic (has a low blood count)
- Disorganized thoughts, confused or uncooperative
- Skin infection on the site of the biopsy
- Ascites (excess fluid in the abdomen)
- Blood clotting difficulties
How do you prepare for a liver biopsy?
Before your liver biopsy, your provider will need to test your blood to determine how well it clots. It is important for your blood to clot properly after the biopsy to prevent excessive bleeding from occurring. All medications that can increase the risk of bleeding should not be taken. These medications include aspirin, aspirin-containing compounds, or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (eg, Motrin® and Advil®), naproxen (eg, Aleve®), blood-thinners like warfarin (Coumadin®), certain medications for those with heart conditions such as abciximab (Reopro®), dipyridamole (Persantine®), ticlopidine (Ticlid®), and clopidogrel (Plavix®), and some natural therapies (like fish oil or ginkgo biloba). NSAIDs are often found in many OTC medications, so it is possible that you may take them without knowing. To ensure you are not taking anything that could put you at risk, share a complete list of any over-the-counter medications you are taking with your provider so they can instruct you on when to stop taking them to ensure a safe biopsy procedure.
Generally, you will have an ultrasound performed on your liver and gallbladder so your provider can confirm the most appropriate location for the biopsy to take place. You will not feel any pain or discomfort during the ultrasound as this machine only uses sound waves to gain visualization of our liver and other organs.
Your provider will give you specific instructions on how to best prepare for the biopsy. These instructions can vary to include not eating or drinking anything after midnight or they may instruct you to have a light breakfast. Some providers recommend a small portion of butter or margarine with breakfast, which can remove the contents from the gallbladder making injury less likely.
Sedation medication may be used during the biopsy, so you will need to arrange for someone to transport you home following the procedure. They can also keep you company during the recovery period after the procedure while our staff monitors your condition. Although patients with primary sclerosing cholangitis are often given antibiotics to lessen their risk of infection, most patients do not require antibiotics before a liver biopsy.
For further information on how to best prepare for your percutaneous liver biopsy in New Orleans, LA, we encourage you to contact your provider.
What is a liver biopsy procedure like?
Generally, when you have a percutaneous liver biopsy, you will arrive for your procedure early in the morning. You will then review your medical history with a nurse or your provider, where you will need to disclose the medications you are taking along with any allergies you may have. At that point, an IV line is placed so that fluids and medications can be administered when needed. You will feel a slight prick when the intravenous line is placed, similar to the feeling of having blood taken. The procedure will be reviewed with you by your provider where you will discuss the reason for the biopsy, possible risks, and alternatives. If you have any questions about the procedure, your provider will be able to answer your questions during this time. Sedation medication may be used to reduce your discomfort and anxiety during the procedure, however, since a biopsy requires your cooperation, it is best to perform the procedure without sedation.
When you enter the procedure room, you will be asked to lay on your back towards the right edge of the examination table. Your provider will begin percussing, or tapping, against the side of your chest while you exhale and hold your breath to locate the ideal spot for your biopsy. This spot will then be marked by your provider to identify the biopsy site. After the site has been marked, alcohol and iodine solution will be used to prep your skin and the entire area will be draped in sterile towels. You will experience a burning sensation while local anesthesia is administered. Your provider will then create a small incision to allow the biopsy needle to travel through the skin with ease.
Before the biopsy, your provider may practice controlled breathing with you. You will be asked to breathe in and exhale completely and then hold your breath while your provider counts to four. This exercise will ensure that during the procedure your provider will be able to perform the biopsy at “end-expiration.” When you exhale completely, your right lung becomes smaller and your liver rises toward the chest. Performing this procedure during end-expiration (when you have completely breathed out), helps to reduce the risk of injury that the biopsy needle may cause to other organs surrounding the liver. It is extremely important that you follow the breathing instructions of your specialist to ensure that your biopsy is as safe and successful as possible.
The actual removal of liver tissue is very fast. It takes approximately one second for the biopsy needle to pass into the liver, remove a small sample of tissue, and come back out again. Automated liver biopsy devices are sometimes used by specialists. When these devices are used, a clicking noise occurs when the needle is deployed. After the biopsy, you will be told to resume breathing and a small bandage will be placed on the incision site. You will be instructed to remain on your right side for two hours for recovery. This can help to decrease the risk of any bleeding by administering pressure against the biopsy site.
What are the possible complications of a liver biopsy?
When performed by experts, such as the GI specialists at Metropolitan Gastroenterology Associates, a liver biopsy is a very safe procedure. Complications resulting in hospitalization happen in only 2 – 3% of patients following a liver biopsy. A biopsy resulting in death is extremely rare, occurring in only 1:12,000 people. Some of the more common issues that may arise include:
- Low blood pressure- Occurs in 10 – 20% of patients. Often due to a vasovagal reaction where the body’s blood vessels expand and the heart rate decreases, similar to fainting. IV fluids, medication for pain, and observation are the best response, however, this reaction can be reversed with medication if needed. Low or falling blood pressure that is persistent may indicate a more serious issue like bleeding.
- Discomfort- Experienced by 25% of patients at the site of the biopsy, right upper abdomen, or right shoulder. Usually subtle or low-grade, may increase when breathing and last for short periods (less than 24 hours), although some patients experience longer periods. Discomfort can be reduced with mild pain medications, such as acetaminophen (Tylenol®). Patients with liver disease can take doses equal to four extra-strength tablets (less than 2g) safely within a 24-hour period. Uncommonly, extreme pain can occur which would require stronger medication. Severe pain should be reported to your provider immediately as it may indicate a more dangerous issue that needs attention.
- Bleeding- Occurs in 0.3% of biopsies. It can take 3 – 4 hours for a bleeding complication to be revealed. Oftentimes, the bleeding will stop on its own accord, however, blood transfusions are sometimes required. If the bleeding is severe and does not resolve on its own, surgery or angiography (procedure to identify and stop the bleeding) may be required.
- Infection- Infection of the biopsy site is very uncommon. Certain liver diseases with blocked bile ducts, such as primary sclerosing cholangitis, may experience infection due to bacteria being released into the blood.
- Perforation- Organs surrounding the liver, like the lungs, kidney, small intestine, and gallbladder, may accidentally be pierced with the biopsy needle. This is generally a minor complication and does not pose a serious issue. However, if the gallbladder is perforated, it may cause bile peritonitis.
- Bile peritonitis- Occurs in less than 1 in 1,000 biopsies. Typically resolves on its own. Following a biopsy, the liver and ducts that contain bile to help digest food may leak. This leakage can irritate the abdominal lining. If the leakage is due to gallbladder damage caused during the biopsy, the gallbladder may need to be removed.
- Medication reactions- Pain and sedation medications are sometimes used in biopsies. Serious reactions are very rare, however, adverse reactions can occur and will require immediate attention. These reactions can include difficulty breathing, low blood pressure, or an allergic reaction. Reactions to lidocaine, or other local anesthetics, are very uncommon.
Are there any restrictions after the biopsy?
After your biopsy, you should make arrangements to rest for the remainder of the day and for the next 5 – 7 days to ensure proper healing. Your provider will give you instructions to avoid all blood-thinning medication and not lift items weighing more than 15 –20 pounds for a full week. Contact your provider immediately if you experience any troubling symptoms such as:
- Pain in the chest
- Difficulty breathing
- Severe shoulder pain or severe pain at the biopsy site
- Pain in the abdomen
- Heart palpitations
- Bleeding from the biopsy site
Liver biopsy to diagnose and evaluate
You should receive your biopsy report within a week. A follow-up appointment will be scheduled with your provider to review the results and discuss treatment options if needed. As a physician-led network of expert gastroenterologists, we strive to provide you with the best possible care available. If you find yourself needing a liver biopsy in New Orleans, LA, trust that you are in good hands with the GI experts at Metropolitan Gastroenterology Associates. Contact your nearest location with any questions you may have or to request a consultation with a digestive health specialist in your community.
Thorough doctor visit. Dr Brenner was professional and personable.
Thanks for a pleasant visit from beginning to end. Bill Hebert
Staff is amazing. I felt so comfortable being a first time patient. First Goldie - she took vitals and was such a delight. Such a compassionate & kind woman. I saw Brooke Stephens ( nurse practitioner). She was very knowledgeable & Thorough. Also kind & compassionate. Natasha came in last & set up necessary test Brooke Ordered,. Another awesome staff member. I felt completely comfortable the entire visit. Thanks to all of you!
Very personable and efficiently run office!