Indications for performing liver biopsies in veterinary medicine include persistently increased liver enzymes (either ALP or ALT in cats but particularly ALT in dogs), persistent hepatic hyperbilirubinemia or increased serum bile acids, evaluation of hepatic lesions found on diagnostic imaging, unexplained hepatomegaly or abdominal effusion, or for evaluation of breed-specific hepatopathies. Several procedures are available for the acquisition of liver tissue. Surgical wedge biopsies are an excellent way to obtain samples with great diagnostic accuracy. However, lesions located deep in hepatic parenchyma may not be easily sampled, and this procedure is usually the most costly and invasive. Tru-cut biopsies can be acquired under ultrasound-guidance but also require patients to be under general anesthesia as with surgical wedge biopsies. They are beneficial for sampling of deeper lesions, but the small sample size may decrease the diagnostic accuracy of the biopsy.

Laparoscopic liver biopsy is the preferred diagnostic sampling technique by many veterinary internists. It allows for direct visualization of the liver surface. Sample size is large enough to provide excellent diagnostic accuracy; however, deep intraparenchymal lesions cannot be reached. Their presence should be ruled out with diagnostic imaging (abdominal ultrasound) prior to biopsy. Multiple biopsies should be taken. At least 2-3 biopsies should be taken for histopathology from both left and right sides of the liver. A sample should also be taken for metal analysis. Liver tissue previously was routinely submitted for aerobic and anaerobic bacterial culture, but a recent study found culture of bile to be more sensitive (Wagner et al. JVIM 2007). Laparoscopy allows for direct visualization of the gall bladder facilitating percutaneous cholecystocentesis.

Evaluation of coagulation status (complete blood count and clotting times) should be performed within 24 hours of the procedure. Serious hemorrhage is an uncommon risk associated with liver biopsies, but a drop in hematocrit is usually noted within five hours of taking the biopsy. Laparoscopic liver biopsy is a minimally invasive procedure that is very safe and effective for obtaining an accurate diagnosis (Petre et al. JAVMA 2012). It is an outpatient procedure, meaning it is routine for patients to be discharged the same day. VCA Alameda East Veterinary Hospital is glad to offer this procedure for your patients. Patients requiring liver biopsies should be referred for consultation to discuss liver biopsy and pros and cons of different methods. We are pleased to be able to work with you to provide collaborative care for your patients/clients.

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Jessica Staker, CVT
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Dr. Whitehouse grew up in southern Georgia. He received a BSA in Biological Science from the University of Georgia in 2007 followed by his DVM from the University of Georgia in 2010. He then completed a small animal internship at the University of Illinois at Urbana-Champaign in 2011 and a small animal internal medicine residency at the University of Wisconsin-Madison in 2014.

Dr. Whitehouse enjoys all aspects of internal medicine but has a special interest in renal diseases, respiratory diseases, and minimally invasive procedures. While at the University of Wisconsin-Madison, his research was focused on feline medicine, specifically chronic kidney disease and hyperthyroidism. He also wrote a review article discussing novel therapeutics in feline medicine.