Vim Silverman Liver Biopsy Needle

It has three parts
Prong/fork/bifid needle- longer than needle and it protrudes out of the needle. It has a very sharp cutting edge and has longitudional grove. This retains the tissue when the needle and canula are withdrawn.

1. What are the indications for liver biopsy
a. In evaluation of jaundice
b. Liver cirrhosis
c. Storage disorders: glycogen storage disease, hemochromatosis, wilson’s disease
d. Granulomatous lesions like tuberculosis and sarcoidosis
e. Infections :viral(CMV, Herpes
and parasitic( Amoebic liver abscess, where it is both diagnostic and therapeutic)
f. To diagnose benign and malignant neoplasms
2. What are the contraindications of liver biopsy
a. Bleeding diathesis
b. Hemangiomas
c. Hydatid cyst
d. Severe ascites
3. What are the prerequisites for a liver biopsy
The patient should not have any bleeding diathesis. PT/APTT should be within normal limits. A baseline LFT should be preferably done. Blood group and cross matching would be ideal, to handle any emergencies due to hemorrhage.
4. What is the site of puncture in liver biopsy procedure
It is in the 9th or 10th intercostal space in the midaxillary area.
5. What are the complications of liver biopsy
a. Hemorrhage
b. Infection
c. Adjacent structures can be injured ( gallbladder, colon, blood vessels)
d. Rarely there can be precipitation of hepatic coma.