Transjugular liver biopsy

Your child’s Transjugular liver biopsy is scheduled for:

 (date)____________  at (time)____________  at Children’s Wisconsin.

When you get to the hospital, stop at the Welcome desk for a badge and directions.

What is a transjugular liver biopsy?

A liver biopsy is done to get a small piece of liver tissue. It can be looked at under a microscope. It may help find the cause of a liver problem.

Transjugular describes how the biopsy is done. A thin tube is threaded through the jugular vein in the neck down to the liver. The biopsy can tell the doctor two things:

• If and why there is a problem with your child’s liver.
• The amount of damage to your child’s liver.

When is it needed?

• When blood tests show that your child’s liver is not working as it should. Liver disease may be suspected based on blood test results. A liver biopsy is done to find the reason that blood tests are not normal.
• When your child’s liver is larger than it should be.
• After a liver transplant:
  – to find the cause of an enlarged liver.
  – to find if the body is rejecting the liver.
• When a percutaneous (through the skin) approach cannot be used. This may happen if:
  – the liver is under the ribs.
  – there is a large amount of fluid in the abdominal cavity (ascities).
  – your child tends to bleed.

How is it done?

Your child will be asleep during the test. It will take about one to two hours.

1. Using an ultrasound, the doctor puts a needle into a vein on the side of the neck, called the internal jugular vein.
2. A soft, floppy wire is fed through the needle, into the vein.
3. The needle is removed.
4. The wire is moved, under x-ray guidance, into the hepatic vein.
5. The biopsy needle is then moved into the hepatic vein in the liver.
6. The biopsies are taken and sent to the lab.
7. The needle is removed and pressure is held at the neck site for a few minutes.
8. The area is bandaged.

What are some of the risks?

• There may be some pain or discomfort after the procedure. The amount of pain varies between children, but is normally mild. If your child has pain, medicine will be given.
• Bruising at the site on the neck where the needle was put in the vein. 
• Bleeding from the liver biopsy site into the abdominal cavity. This is rare.
• An infection caused by the procedure. This is also rare.
• The structure of the liver veins does not allow the procedure to be completed. This is very uncommon.
• Sometimes, the biopsy does not help with the diagnosis.

What to stop and when to stop

Solid food and whole milk
Stop 8 hours before the scan.

Formula
Stop 6 hours before the scan.

Breast milk
Stop 4 hours before the scan.

Clear liquids
Stop 2 hours before the scan.

Please note: It is important that you follow these special instructions. If your child eats or drinks anything after the times listed above, the test may be cancelled.

What happens after the procedure?

• Your child will need to stay in bed for 4 to 6 hours after the test. Some children stay in the hospital overnight. During recovery, the nurse will monitor your child closely.
• If your child is in pain, the nurse can give your child some pain medicine.
• A blood test will be done a few hours after the procedure. It is done to make sure there are no changes from the earlier blood tests. After you leave the hospital, check the area of the biopsy for swelling, bleeding or bruising every day for one week.