Most patients with AIH will have had a liver biopsy at some point. Primarily because they are one of the most accurate diagnostic procedures for AIH. I have had a few since I was diagnosed to measure the level of damage to my liver over the years. Once my liver was confirmed as cirrhotic, there were no more biopsies as there was essentially no point in having them done. The damage to the liver was beyond repair and whilst the treatment was most probably slowing down any damage, it was unlikely to improve. These biopsies were all undergone the traditional way, i.e a sample of the liver was taken by entering through the rib-cage. This is most often carried out under sedation with local anaesthetic and involves a needle being inserted into the liver to take a sample of the tissue. On the whole, it is a relatively painless procedure however, as with all types of procedure, there can be complications. One that I once experienced was having a nerve caught by the needle which caused considerable pain in my shoulder known as referred pain.
The biopsy that I was to have after my transplant is known as a transjugular biopsy. In this procedure, a tiny biopsy needle is inserted into a vein in the neck and using ultra sound as a guide, is threaded down the vein and into the large vein in the liver, the hepatic vein. From there, a sample of the liver is taken as in the regular biopsy. This is repeated 3-4 times until enough useable samples have been gathered.
I was terrified. Unfortunately I had read a few horror stories of these biopsies through the support groups and had got myself really worked up about it. When I was told I wouldn't be able to have sedation, I began to get quite upset. I didn't have any family with me at this point to hold hands with or to be strong in front of or cry in front of. So I cried anyway.
The team were incredibly reassuring and reminded me of the importance of having the biopsy done and getting the results back quickly. I dried my tears and went in, even managing a few jokes here and there.
As the team were preparing for the biopsy, I heard mention of my platelet count. Apparently it was 90. I was in shock and thought I must have misheard them. Pre-transplant, my platelets ran at around 20-25 so at hearing 90, I figured they must have said 19 but was reassured otherwise. I was slid from my bed onto the biopsy table. I then had a sort of tent attached to my neck which covered my face but didn't touch it. This meant I wasn't able to see what was going on - definitely a good thing!
Where the 'tent' was attached to my neck, there was a small area through which the procedure would take place. I was then given an anaesthetic injection into the vein that would numb the area and the vein itself. Once that had set to work, the procedure could begin. I felt a pressing sensation on my neck that was a little bit uncomfortable. I then felt the strangeness of the biopsy needle moving through the vein. Finally, there was a click and again, a small sensation of pressure on the liver and the needle was removed. This was repeated another few times so that they could ensure that there were enough samples of good enough quality to assess. A small stitch was used to close the entry area and I was ready to go on my way.
The whole thing took less than 20 minutes and I was back on the ward with a small square plaster covering the biopsy area. I was advised to stay flat in bed for the next 4 hours to prevent any bleeding from the biopsy area.
Overall, the experience was nowhere near as horrific as I had expected. In fact, it was mont bad at all. I wouldn't say it was something I enjoyed or that I would like to have done on a regular basis, but I was prepared for an awful lot worse.
I hope that this account puts some people at ease.
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| The tiny steri-strips that can just about be seen on my neck are where the biopsy went in and this is the only sign that it took place. |
For further information about liver biopsies, please take a look at the following links:
British Liver Trust: Other Diagnostic Procedures
Guys and St Thomas's Guide to Liver Biopsies
Keep Smiling :)
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