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Consent to Perform Hepatic (Liver) Biopsy

VetBooks.ir Patient name:_________________________________
Pet owner’s name:_____________________________ Med rec #____________
Best contact during/after procedure (e.g., cell phone number):____________________

INTRODUCTION obtain multiple biopsies, which are larger in size than those
We want to make sure that you understand the planned medical obtained by the needle biopsy technique. A camera on a long
procedure to be performed on your pet. You should know why the tube (a laparoscope, which is a kind of endoscope) is inserted
procedure has been suggested, what the potential benefits are for into the abdomen through a small surgical incision in the body
your pet, and the most common/important risks of the procedure. wall less than an inch (2.5 cm) long. To obtain a better view of
Alternatives to this procedure, when applicable, will be discussed the liver and the other organs, the abdomen is temporarily filled
with you. It is also important that you recognize that medicine is with gas, much like filling a balloon. Additional small incisions are
not an exact science, and that the outcome cannot be guaranteed. created to insert instruments into the abdomen to aid in obtaining
We encourage you to ask us as many questions as required for samples of liver tissue. Using the camera, the biopsy sites are
you to make a well-informed decision. examined for bleeding. The endoscope is then removed, and a
few sutures (stitches) or surgical staples are used to close the
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE small openings in the skin created during the surgery. Biopsies
The liver is a vital organ that produces proteins and detoxifies are then submitted for evaluation.
potentially harmful substances, among other functions. Liver biopsy 3. Open liver biopsy with abdominal exploratory surgery (laparotomy):
allows us to obtain a small piece of liver tissue to try to determine the This is a full-fledged abdominal surgery. This is the most invasive
cause of liver disease. Usually, the tissue sample will be examined option to obtain liver biopsies, but it also provides the chance to
under a microscope by a veterinary pathologist. Additional testing not only see but also feel the liver to identify abnormal tissue, to
(such as measuring the levels of copper in the liver or conducting obtain excellent samples from any liver lobe, to readily control
bacterial culture) may be necessary as well. Liver biopsies provide bleeding, or sometimes even to remove a liver mass. Laparotomy
objective information that we use for choosing treatments. Ideally, also permits evaluation of the rest of the abdominal organs, with
results from the biopsy will help determine a specific cause for biopsy of any that pose a worry. Of course, this requires a long
your pet’s illness in order to design the most effective treatment for surgical incision and recovery will take a few more days than with
that illness and to provide you with useful prognostic information the other techniques. As with the other methods, liver biopsy
(information on expected long-term evolution and outcome). samples will be submitted for appropriate testing (microscopic
examination, infectious disease testing, copper concentrations,
EXPLANATION OF THE PROCEDURE etc).
Reasons for obtaining a hepatic (liver) biopsy include: Additional procedures planned for your pet at the same time
1) Abnormal liver function tests as the liver biopsy:
2) Persistently elevated liver enzyme levels
3) Abnormal liver size or architecture (single or multiple masses) ____________________________________________________________
There are several methods for obtaining a liver biopsy. The
method recommended for your pet will take into consideration the USE OF SEDATIVES OR ANESTHESIA
reason the biopsy is needed, the size and health of your pet, and General anesthesia causes your pet to become unconscious
the size and location of any abnormal liver lesion, if any. Regardless temporarily, allowing the biopsy to proceed. Although anesthesia
of the method, your pet will undergo general anesthesia for the is performed routinely with good outcomes, it does bring risks,
procedure. Methods for obtaining a liver biopsy include: including a very small risk of death. These risks are increased for
1. Ultrasound-guided needle-core biopsy: In this technique, the animals with severe disease. To reduce these risks, your animal will
pet is under general anesthesia and a large specialized needle be monitored closely during both anesthesia and during recovery
is inserted into the abdomen and liver using guidance from an from anesthesia. The decision to perform this procedure is based
ultrasound machine. It is less invasive than a full-fledged surgery on having assessed that the anticipated benefit is greater than the
(laparotomy), but it provides smaller samples for evaluation than a anesthetic risk.
surgical biopsy does. An ultrasound examination of the abdomen
is performed prior to procedure to identify the area that will be FORESEEABLE RISKS TO THE PROCEDURE
biopsied, and the overlying skin is prepared as it would be for • The major risk with all liver biopsy procedures is hemorrhage
a surgery. A needle-core biopsy instrument is used to take (bleeding). To help prepare for and prevent this complication,
several specimens of liver tissue. The ultrasound will be used your pet’s platelets and clotting factors will be assessed prior
to scan for postbiopsy bleeding. One or two sutures or staples to surgery. Counterintuitively, the risk of uncontrolled bleeding
may be placed to close the skin incision, if needed. The patient is greater for the less invasive methods of biopsy than it is
is hospitalized for at least the remainder of the day to monitor for laparotomy. If severe, excessive bleeding might require
recovery and identify complications if they were to occur, and laparotomy to stop the hemorrhage, even if the biopsy was an
samples are submitted for appropriate testing. ultrasound-guided needle biopsy. The most severe cases of
2. Laparoscopic liver biopsy: This technique is more invasive than postbiopsy bleeding might also require blood transfusion. Your
an ultrasound-guided needle biopsy, but less invasive than pet may be monitored for bleeding for up to 24 hours after the
laparotomy. It allows us to see the liver before and after we biopsy, depending on individual circumstances.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.