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What is Liver Biopsy?

The liver is an amazing organ that plays a multitude of roles in maintaining good health. Given the number of duties the liver undertakes, a rise in liver enzymes alone on a blood test tells the clinician very little as to the cause of the problem. Indeed, because the liver 'cleans' the blood, the rise may even be due to pressure on the liver due to non-liver-related illness. 

What's for sure is that untreated liver disease progresses more rapidly than treated, with the risk of complications and extensive scar tissue formation. The gold standard for diagnosing the exact nature of liver disease remains taking a biopsy sample. This enables a histologist to examine the structure on a cellular level to determine the problem and the best treatment for it. 

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Liver Biopsy Procedure in Dogs

There are several options for obtaining a sample of liver tissue. These methods vary in invasiveness and the size of sample obtained. However, regardless of which method is used, it's important to check the dog does not have a coagulopathy (difficulty clotting blood) prior to sampling, as the liver has a large blood supply and is prone to bleeding. 

Ultrasound guided biopsy

Usually performed under deep sedation or full anesthesia. An ultrasound image is used to guide placement of a large bore biopsy needle. This is the least invasive method as it only requires a small nick in the skin. However, the sample harvested is small, and there is a risk of missing relevant pathology. 

Laparoscopic biopsy

Also known as keyhole surgery, this is performed under anesthesia and involves passing a laparoscope through a small incision in the skin. A small camera allows the surgeon to see the liver and identify the best area to harvest. This is moderately invasive and collects a sample size intermediate between a needle biopsy and wedge biopsy. 

Wedge biopsy taken during a laparotomy

A laparotomy (surgically opening into the abdomen) is performed under general anesthesia. The surgeon can directly examine all the abdominal organs, and chose the exact piece of liver they wish to harvest. This allows for collection of wedges of liver, which are of high diagnostic value. 

Efficacy of Liver Biopsy in Dogs

Liver biopsy is a tool that facilitates the clinician reaching a diagnosis. How useful a biopsy sample is for diagnostic purposes depends on the size of the sample and the area sampled. For example, an ultrasound guided biopsy is most useful for generalized liver disease, where the chances of sampling an area affected by the process is high. That said, if the disease is localised, the ultrasound image helps guide the clinician to the relevant area. 

To reach an accurate diagnosis the histologist needs to see 16 triads (an architectural landmark within the liver) worth of tissue. This is easily achieved with the second two methods of sampling. 

Unfortunately, the implication is that if too small a sample is obtained, or it is harvested from an area that doesn't represent the ongoing pathology, that a 'normal' sample can be obtained despite the dog having liver disease. The chances of this are minimized via laprascopic or laparotomy collection. 

Liver Biopsy Recovery in Dogs

The recovery time to a large extent depends on how sick the patient was initially, and the method of collection. For a fit dog that has a sample collected via ultrasound guidance, they may be bouncing around again within 2 - 3 days of the anesthetic. 

For dogs that undergo laparotomy, the recover time is around two weeks, which is also the time until the skin incisions is healed. However, it may be necessary to rest the dog and avoid vigorous exercise for 3 - 4 weeks, since some types of liver disease can result in delayed healing times. 

Cost of Liver Biopsy in Dogs

The cost of a liver biopsy needs to be considered as part of a larger procedure, since it will invariably involve imaging (such as ultrasound) or invasive surgery (such as laparotomy), plus anesthesia. 

The cost of an ultrasound scan varies depending on the experience of the operator, but a fee of around $200 is to be expected. The cost of histology by an outside laboratory is typically around $80 - $100, with specialist stains looking for copper or the like being additional to this. 

The cost of a  full general anesthesia and laparotomy depends on the dog's size and how long the procedure takes. A minimum fee of $750 is to be expected. 

Because a liver biopsy is liable to be performed on a sick dog, anticipate extra fees such as intravenous fluids (estimated $50) or drugs such as vitamin K injections. 

Dog Liver Biopsy Considerations

The are risks associated with liver biopsy, of which the greatest is hemorrhage. This is because the liver is richly served with blood vessels, added to the fact that a disease liver may not produce enough clotting factors which leads to a tendency to bleed. 

The clinician will carefully screen the dog prior to surgery, to identify any bleeding tendencies. If a problem is detected, this can mean postponing surgery until that issue is corrected. Action may mean giving vitamin K injections or a transfusion of plasma-rich with clotting factors. 

Other considerations include balancing the invasiveness of the procedure against the size of sample obtained and visualization to choose the most useful piece of tissue. Thus, although laparotomy is the most invasive method, it is also the one most likely to harvest a diagnostic sample. 

Liver Biopsy Prevention in Dogs

Prevention of the need for a liver biopsy is largely a matter of preventing liver disease and promoting good health. Conditions such as infectious canine hepatitis are largely preventable through regular vaccination, so keeping up to date with innoculations is advisable. 

Some pedigree breeds such as Bedlington terriers are prone to an inheritable form of liver disease, so screening of parent stock prior to breeding is essential. When carriers of inherited liver disease are detected, then they should not be breed from. 

Liver enzymes can be elevated due to non-liver disease, such as Cushing's disease or even dental infections. With this in mind, the clinician may need to running tests screening for these other problems, in order to rule them out (or reach a diagnosis which makes the need for a liver biopsy redundant).

Liver Biopsy Questions and Advice from Veterinary Professionals

Brini
Yorkshire Terrier
12 Years
Mild condition
-1 found helpful
Mild condition

Has Symptoms

Enlarged liver

Medication Used

Denamarian

I have a Yorkshire terrier, almost 13, has high blood pressure, trechhia issues, pooping knee caps, but most recently an abnormal ultrasound of her liver that showed an ENLARGED liver and she has elevated liver enzyme values. Elevated blood counts are RBC - 9.13, HEMATOCRIT - 57.0, Platelet - 560, Platelet count manual if indicated - 558, ALT - 174, ALP - 452. She has taken Denamarian for a year and liver values would go down. Being on preicox for knees would bring liver values back up. Vet did ultrasound and does not think it’s cancer but isn’t sure what it could be otherwise. He also does not think it’s cushings because adrenal glands appear normal. He wants to do a guided needle biopsy. I’m concerned due to age and blood pressure. She is also really struggling to walk because of her knees and arthritis. Is the biopsy a good idea?

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2499 Recommendations
This is your third question asking if a liver biopsy is appropriate or not for Brini, some cases are never as straightforward as yes or no especially when we haven’t personally examined a patient ourselves (we’re not talking about draining oil from a car). If you have concerns, you should visit another Veterinarian for a second opinion because on paper it may seem suitable but not once you’ve made a physical examination. Regards Dr Callum Turner DVM

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Brini
Yorkshire Terrier
12 Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

Blood counts, BP, abnormal liver

I have a Yorkshire terrier, almost 13, has high blood pressure, trechhia issues, pooping knee caps, but most recently an abnormal ultrasound of her liver and elevated liver enzyme values. Elevated blood counts are RBC - 9.13, HEMATOCRIT - 57.0, Platelet - 560, Platelet count manual if indicated - 558, ALT - 174, ALP - 452. She has taken Denamarian for a year and liver values would go down. Being on preicox for knees would bring liver values back up. Vet did ultrasound and does not think it’s cancer but isn’t sure what it could be otherwise. He also does not think it’s cushings because adrenal glands appear normal. He wants to do a guided needle biopsy. I’m concerned due to age and blood pressure. She is also really struggling to walk because of her knees and arthritis. Is the biopsy a good idea?

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2499 Recommendations
Abnormal ultrasound of the liver isn’t very descriptive; was the liver enlarged? Was there a mass(es)? Other issues? It is difficult to know whether or not a needle aspirate or biopsy is indicated without knowing more. A needle aspirate of the liver may be indicated to send for histopathology so that the types of cells and morphology of cells may be examined to see if this helps to narrow down a diagnosis. Regards Dr Callum Turner DVM

She has an enlarged liver

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Brini
Yorkshire Terrier
13 Years
Mild condition
0 found helpful
Mild condition

Has Symptoms

Blood pressure, elevated liver val

I have a Yorkshire terrier, almost 13, has high blood pressure, trechhia issues, pooping knee caps, but most recently an abnormal ultrasound of her liver and elevated liver enzyme values. She has taken Denamarian for a year and liver values would go down. Being on preicox for knees would bring liver values back up. Vet did ultrasound and does not think it’s cancer but isn’t sure what it could be otherwise. He wants to do a guided needle biopsy. I’m concerned due to age and blood pressure. She is also really struggling to walk because of her knees and arthritis. Is the biopsy a good idea?

Dr. Michele King, DVM
Dr. Michele King, DVM
1079 Recommendations
Without knowing more about her actual liver values and other conditions, I can't comment on whether the biopsy is necessary. It might be a good idea to have a second opinion, just to make sure that there aren't any other options or possibilities, before having the procedure done. I hope that everything goes well for Brini.

Hi there! Thanks for responding. I have the blood counts if you don’t mind reviewing those and providing me with another response. RBC - 9.13, HEMATOCRIT - 57.0, Platelet - 560, Platelet count manual if indicated - 558, ALT - 174, ALP - 452

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Bailey
Mix
11 Years
Moderate condition
0 found helpful
Moderate condition

I adopted a ten year old senior beagle mix. He's got elevated liver enzymes (ALT in the 400's, down from 700's) but his appetite is low and very fickle. Some vets have recommended biopsies, others caution against it as it can be dangerous for older dogs with liver issues. However, he does not eat a lot and is not very active, so I am not sure if I should take my chances as it seems his quality of life is not so great right now anyway. He has been on denamarin for close to 3 weeks (and "liver happy" for 2 weeks) but seems to be even less interested in food now. I just don't know what to do.

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2499 Recommendations
A liver biopsy would be useful in determining a possible cause for the increase in liver enzyme values, but this needs to be balanced against Bailey’s health in general; any decision to do a biopsy would be at the discretion of a Veterinarian which has examined him in person. If you are concerned about a biopsy, an ultrasound may be useful to look for abnormalities and other pathologies. Regards Dr Callum Turner DVM

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Pupun
Pomeranian
3 Years
Serious condition
0 found helpful
Serious condition

Has Symptoms

Yellow urine
Vomiting

Medication Used

Lysibin
Doxycycline
Alkapro
Viusid

SGPT & SGOT counts are increasing every month for my Pomeranian pet of age 3 yr. Those are currently 342 and 162. Dr is suggesting to go for a liver biopsy next time. Before 3-4 months he was affected by E Canis. However now that problem is cured. Please advise what to do to get his liver in normal condition. Does those counts indicate any permanent cell damage at this level? We are eager to get any kind of help as soon as possible. Thanks in advanced

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2499 Recommendations
There is no single way to solve liver disease or an increase in liver enzymes, it is important to determine the underlying cause of the problem and to treat that; infections, parasites, bile duct disorders, poisoning, shunts among other causes may cause an increase in liver values. Once the underlying cause is identified treatment can be given directly along with supportive and symptomatic care; in the meantime, if you aren’t already, give Denamarin (silybin and SAMe) to help with the liver. Regards Dr Callum Turner DVM

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Misty
Shetland Sheepdog
12 Years
Serious condition
2 found helpful
Serious condition

Would it be worth putting a 12 year old dog through the procedure of biopsy having to be surgically opened when they are already showing signs of nausea not eating tiredness diaorriha not taking drugs. Normal life expectancy usually not past 14 yrs

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2499 Recommendations
It really depends on the rationale for the biopsy; if ultrasound, x-rays and blood tests have so far not managed to confirm a diagnosis, then a biopsy of the liver may indeed be the next diagnostic step. Whether or not it is worth it is down to individual opinion; whilst it is important to make a diagnosis, would you want to put Misty through that procedure and the recovery? Is the liver being biopsied or a mass on the liver? Would an ultrasound guided fine needle aspirate be sufficient which may be performed without opening the abdominal cavity? Regards Dr Callum Turner DVM www.ivis.org/proceedings/navc/2005/SAE/160.pdf?LA=1 www.cliniciansbrief.com/sites/default/files/attachments/Liver%20Ultrasound-Guided%20Fine-Needle%20Aspiration.pdf

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Jami
Collie, Rough
9 Years
Mild condition
1 found helpful
Mild condition

Has Symptoms

Jami is asymptomatic.

My nine year old collie was t-boned by a deer resulting in his having an arthrodesis of his front leg. The orthopedic surgeon ordered a bile acid test because his CBC had an ALT of 210 ;ALKP OF 192 AND CREATINE KINASE was 256. The bile acid,too, was high, 12. The internist said no NSAIDS. He did an ultrasound and found Jami’s liver to be slightly inflamed. He put him on Marin, Denamarin and ursidiol. After a month his ALT WAS 154; and ALKP. 166; Another month later his ALT went up to 173. The internist wants a liver biopsy. Jami has no symptoms. His eating, etc. are normal. Is a needle biopsy necessary? Will a needle biopsy give enough sample to make a more specific diagnosis possible?

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2499 Recommendations
Whilst Jami is asymptomatic (for now), it is important for us to determine why the liver enzymes are elevated so that a treatment or management plan can be put in place before the levels get higher. A needle biopsy will allow a sample to be collected easily for examination and will allow a Pathologist to see the types of cells, structure of cells, numbers of cells etc… and can determine if there is an underlying pathology to be concerned about. Regards Dr Callum Turner DVM

Thanks, Doctor. Then we will continue with the liver support meds for another three weeks (a month after the last) and if ALT is still elevated, have the liver biopsy. Today the orthopedist said that Jami was much better at walking, etc. then could have been expected. We appreciate your input. After the deer incident, we didn’t want to put him through anything unnecessary.
Gail

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Rowdy
Jack Russell Terrier
12 Years
Serious condition
0 found helpful
Serious condition

Has Symptoms

Wont eat

My Jack Russell 12 years old recently would not eat for a couple of days so took him to vet they did blood work - his liver levels were high so they wanted to do an ultrasound and keep him in the hospital for a day they ended up doing a sonogram needle biopsy which was inconclusive - they put him on 2 antibiotics and a Liver detox pill as well as an appetite stimulant - he is back to his old self however it is difficult to figure out from day to day what he will eat (lot's of people food - occasionally will eat dog food). We just did a bile acid test in which the numbers were high off the charts - they now want to do a full surgical biopsy - I am tempted to stick with the supportive treatment and not put him through a surgery - any advise? (he has not lost any weight - so we are getting him to eat enough)

Dr. Michele King, DVM
Dr. Michele King, DVM
1079 Recommendations
Thank you for your question. Liver disease can be tough to diagnose, and to manage, as without the biopsy, we're making educated guesses. If they did the ultrasound and didn't see any signs of neoplasia or cancer, and he is responding to his medications, you should have a serious conversation with your veterinarian on what your preferences are. He can stay on liver supplements for life if he continues to respond, and his bile acids may improve on those medications. We often recheck the blood values after 2-3 weeks of being on the supplements to see how the liver is responding. Whether you decide to have the biopsy is up to you and your veterinarian. It will give more answers as to how to treat his disease, but he may be doing well enough on the supplements that you elect that route of treatment. I hope that he continues to do well.

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Paddy
Staffordshire Bull Terrier Cross whippet
7 Years
Mild condition
0 found helpful
Mild condition

Has Symptoms

Sickness

Medication Used

cerenia 20ml vial
Intravenos fluids

I’m unsure of the serverity of the condition or what the actual issue is there aware of liver issue due to an elevation in certain factors in the blood, they don’t know the cause of the issue.. he’s ALP:2000 ALT1100 GLU:6.6 .
I’m unsure if a biopsy would help in this situation or any other advice you can give?

Dr. Michele King, DVM
Dr. Michele King, DVM
1079 Recommendations
Thank you for your question. I can't comment on Paddy's situation, unfortunately, without more information. That ALT is very high. That degree of liver damage could be due to an acute injury, a toxin, a chronic liver condition, or cancer. Sometimes an ultrasound can be helpful in cases of liver disease, as it allows us to visualize the liver without actually performing surgery. IF your veterinarian has already done that, or feels that a biopsy is the next best step, that is probably true. The benefit of a liver biopsy is that you have an actual piece of tissue that can be analyzed to find out why it is so angry, and how to treat the disease specifically. I hope that Paddy is okay.

It’s only come on over the course of a week, he’s shown signs of sickness,dioreah,gaundice,lethargy, there unsure of the cause and said they would contact me after monitoring him. I feel at a slight loss for things that may help? Ways this may effect his longievity and what’s the normal course of action in these situations (the possibility of liver recovery) and possibilities of excessive cost for medication?

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