Most accurate in disorders causing diffuse changes throughout the liver; subject to sampling error in focal infiltrative disorders such as metastasis; should not be the initial procedure in the diagnosis of cholestasis. Contraindications to performing a percutaneous liver biopsy include significant ascites and prolonged international normalized ratio (INR). In such settings, the biopsy can be performed via the transjugular approach.
For a more detailed discussion, see John S, Pratt DS: Jaundice, Chap. 58, p. 279; Ghany MG, Hoofnagle JH: Approach to the Patient with Liver Disease, Chap 357, p. 1989; and Pratt DS: Evaluation of Liver Function, Chap. 358, p. 1995, in HPIM-19. |
Section 3. Common Patient Presentations