INDICATIONS FOR LIVER BIOPSY

 

Diagnosis, grading, and staging of alcoholic liver disease, nonalcoholic steatohepatitis, or autoimmune hepatitis

Grading and staging of chronic hepatitis C or chronic hepatitis B

Diagnosis of hemochromatosis in index patient and relatives, with quantitative estimation of iron levels

Diagnosis of Wilson’s disease, with quantitative estimation of copper levels

Evaluation of the cholestatic liver diseases primary biliary cirrhosis and primary sclerosing cholangitis

Evaluation of abnormal results of biochemical tests of the liver in association with a serologic workup that is negative or inconclusive

Evaluation of the efficacy or the adverse effects of treatment regimens (e.g., methotrexate therapy for psoriasis)

Diagnosis of a liver mass

Evaluation of the status of the liver after transplantation or of the donor liver before transplantation

Evaluation of fever of unknown origin, with a culture of tissue

CONTRAINDICATIONS TO PERCUTANEOUS LIVER BIOPSY.

"Absolute contraindications"

Uncooperative patient

History of unexplained bleeding

Tendency to bleed

 * Prothrombin time »3–5 sec more than control

* Platelet count <50,000/mm3

* Prolonged bleeding time (»10 min)

Use of a nonsteroidal antiinflammatory drug 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