A dog liver biopsy procedure may have been recommended for your dog and you may be wondering about the what the procedure entails and its associated costs. There are actually several techniques veterinarians rely on in order to obtain a liver biopsy. The choice of one technique over the other is based on several factors such as the veterinarian's preference, the overall health of the dog, the size of the liver, the size of the dog and the owner's finances, considering that certain medical procedures are more costly than others.
Dog Liver Biopsy Procedure
A dog liver biopsy procedure may be suggested when the vet suspects some type of liver disease. Affected dogs may have increased liver enzymes on their serum biochemistry profile, abnormal bile acid concentrations, or their ultrasound may have shown changes that require investigation.
A biopsy is indicated when such results were not adequate enough to establish a definite diagnosis. A dog liver biopsy procedure can help pinpoint potential underlying conditions such as inflammation, infection, cancer and other conditions affecting the dog's liver.
The biopsy, which consists of obtaining a tissue sample from the liver, can provide information on whether there is presence of abnormal cells in the liver, such as cancer cells, or whether there may be some ongoing disease processes at play.
"Although our diagnostic techniques continue to improve, in most instances imaging and biochemical testing cannot replace a liver biopsy. This is by far the best examination for a definitive determination of the nature and extent of hepatic damage and to appropriately direct the course of treatment."~Dr. David Twedt, board-certified veterinarian
Dog Liver Biopsy Techniques
There are several techniques used to obtain a liver sample in dogs. Examples include fine needle aspiration, ultrasound-guided biopsy, laparoscopy and laparotomy.
Fine-needle aspiration (percutaneous) may be the method of choice for dogs who are not in stable conditions or for dogs who are affected by some type of severe bleeding disorder. This procedure simply requires inserting a thin needle through the abdomen and into the liver. Sedation is typically not needed for this. The sample is then looked at under a microscope (cytology). While less invasive, a fine needle aspirate offers the disadvantage of not providing accurate results as a wedge biopsy may.
Ultrasound-guided biopsy is also prone to variables in the quality of samples obtained. The issue is that the sample obtained by a biopsy needle is small compared to that obtained by a wedge-biopsy. However, this type of biopsy method offers the advantage of identifying the exact location of any troublesome areas via ultrasound prior to obtaining the biopsy.
Laparascopy has it place when it comes to dog liver biopsy procedures. The advantage of using laparoscopy (a minimally invasive technique, often referred to as "keyhole surgery") is less pain after surgery and a faster recovery time compared to traditional open surgical techniques.
In this procedure, tube-like instruments collect the biopsy sample through small incisions (ports) in the abdomen. Since small instruments are used, there is no need for the vet to make an incision that is large enough to insert his hands to get a sample. Usually, the procedure lasts anywhere between 15 minutes to half hour and the small incisions will need only two to three sutures. Laparoscopic liver biopsy offers a better visual of the location, but still the volume of the sample collected is inferior to the samples collected through surgical wedge biopsy.
Traditional abdominal surgery, known as laparotomy or celiotomy, offers the best option for a definitive diagnosis. It's indeed, considered the gold standard method. In this procedure, a wedge-shaped sample of tissue from the liver is obtained. However, it's also the most invasive method.
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What Happens at the Vet
Dog Liver Biopsy Costs
Prior to obtaining a liver biopsy, your vet may want to run several blood tests such as complete blood count, platelet count, serum chemistry profile and coagulation tests. A urine test may be helpful too. These tests can help the vet better assess the condition of the dog and how to proceed.
For instance, in the case of dogs with liver disease and a history of vomiting, the vet may want to correct any magnesium or potassium deficiencies which may cause complications during surgery such as heart arrhythmia. Dogs with severe liver diseases may have prolonged blood clotting times and therefore may require preparation measures in case a transfusion is needed.
If cancer is suspected, potentially affected dogs should have chest x-rays and possibly an ultrasound first for staging purposes. A needle aspirate during an ultrasound may be sufficient to confirm presence of cancer at times sparing the dog from undergoing surgery to obtain a biopsy.
On surgery day, the dog should have been fasting for at least 12 hours. The vet will then administer fluids and pain medications. If there are underlying conditions that may have an impact during surgery, further medications may be provided. Next, the vet will induce anesthesia. Fur will be clipped by the surgical site. An endotracheal tube will be inserted. The dog will be hooked up then to machines that will monitor breathing heart rate, blood pressure and oxygen levels.
Next, the vet will obtain the biopsy sample using choice of the techniques described above. The area will be sutured, and the dog will then, recover in a quiet area. Fluids and pain meds will likely be administered. The sample is then sent off to a pathologist for interpretation.
Complications from a dog liver biopsy procedure are not very common. They are more likely to happen in dogs suffering from blood clotting disorders and levels of low numbers of platelets in the blood. Dogs with low albumin levels and liver function impairments are more likely to have complications such as low blood pressure and problems metabolizing the anesthetic and pain medications.
As with any surgery that involves cutting through skin, there are always some risks for infections and bleeding. Your dog will need to be monitored for several hours after the dog liver biopsy procedure for any signs of bleeding. Consult with your vet if your dog's incision is not healing properly.
Costs for a dog liver biopsy obviously may vary greatly from one place and another. The best way to obtain pricing is by calling around several vets clinics and see if they are willing to provide some rough estimates.
Generally, expect a liver biopsy procedure to cost anywhere between $500 and $1,500. Going to a a teaching hospital may help reduce these costs.
- DVM360: Surgery STAT: The finer points of laparoscopic liver biopsies
- DVM360: How to perform a surgical hepatic biopsy
- Tufts University: Minimally Invasive Surgery Reaches the Veterinary Operating Room