Liver Biopsy
Pediatric Liver Biopsy
Key Points
- Gold standard for diagnosis of many pediatric liver diseases
- Multiple approaches available (percutaneous, transjugular, laparoscopic)
- Requires careful pre-procedure planning and monitoring
- Essential role in diagnosis, staging, and treatment monitoring
- Specimen adequacy crucial for accurate diagnosis
Definition
Liver biopsy is a procedure to obtain liver tissue for histological examination, which provides valuable information about liver architecture, inflammation, fibrosis, and specific pathological processes affecting the liver.
Primary Indications
- Diagnostic:
- Neonatal cholestasis
- Biliary atresia
- Autoimmune hepatitis
- Metabolic liver diseases
- Wilson's disease
- Unexplained hepatomegaly
- Disease Monitoring:
- Assessment of disease progression
- Evaluation of treatment response
- Post-transplant monitoring
- Rejection surveillance
- Specific Conditions:
- Chronic viral hepatitis
- Non-alcoholic fatty liver disease
- Storage disorders
- Unexplained liver enzyme elevation
Pre-Procedure Assessment
- Laboratory Studies:
- Complete blood count
- Coagulation profile (PT, INR, PTT)
- Liver function tests
- Blood type and screen
- Imaging:
- Ultrasound of liver
- Assessment of:
- Liver size and echogenicity
- Vascular anatomy
- Focal lesions
- Ascites
- Risk Assessment:
- Bleeding risk evaluation
- Anatomical considerations
- Sedation/anesthesia planning
- Contraindications review
Contraindications
- Absolute:
- Uncooperative patient
- Severe coagulopathy (INR > 1.5)
- Severe thrombocytopenia (< 50,000)
- Active cholangitis
- Relative:
- Ascites
- Vascular tumors
- Right pleural effusion
- Morbid obesity
Essential Equipment
- Biopsy Equipment:
- Biopsy needles:
- Menghini needle
- Tru-Cut needle
- Jamshidi needle
- Ultrasound machine
- Sterile probe cover
- Biopsy needles:
- Procedure Kit:
- Sterile drapes and gowns
- Antiseptic solution
- Local anesthetic
- Syringes and needles
- Specimen containers
- Dressing materials
- Emergency Equipment:
- Resuscitation cart
- Pressure bags
- Blood products
- Monitoring equipment
Procedure Steps
- Patient Preparation
- NPO status verification
- Informed consent
- Appropriate positioning
- Sedation/anesthesia administration
- Site Selection
- Ultrasound marking of:
- Optimal entry point
- Needle trajectory
- Depth measurement
- Anatomical considerations:
- Avoid vessels
- Avoid gallbladder
- Right intercostal approach
- Ultrasound marking of:
- Procedure Execution
- Sterile preparation
- Local anesthetic administration
- Real-time ultrasound guidance
- Breath-hold technique
- Rapid needle passage
- Core specimen acquisition
Potential Complications
- Major Complications:
- Hemorrhage
- Bile leak
- Pneumothorax
- Organ perforation
- Minor Complications:
- Pain
- Vasovagal reactions
- Local infection
- Small hematoma
- Prevention Strategies:
- Proper patient selection
- Ultrasound guidance
- Correct technique
- Post-procedure monitoring
Post-Procedure Care
- Immediate Care:
- Vital signs monitoring
- Pain assessment
- Position maintenance
- Compression dressing
- Monitoring Period:
- 4-6 hours observation
- Hemodynamic monitoring
- Activity restrictions
- Diet advancement
- Discharge Criteria:
- Stable vital signs
- Adequate pain control
- No bleeding
- Tolerating oral intake
Specimen Handling
- Immediate Processing:
- Fixation methods
- Fresh tissue requirements
- Special studies preparation
- Specimen adequacy assessment
- Standard Analysis:
- H&E staining
- Trichrome staining
- Reticulin staining
- Iron staining
- Special Studies:
- Immunohistochemistry
- Electron microscopy
- Genetic studies
- Metabolic studies
Reporting Elements
- Essential Components:
- Specimen adequacy
- Architecture assessment
- Inflammatory activity
- Fibrosis staging
- Special stain findings
