{"id":33243,"date":"2023-10-17T17:59:56","date_gmt":"2023-10-17T17:59:56","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=33243"},"modified":"2023-10-17T17:59:56","modified_gmt":"2023-10-17T17:59:56","slug":"visceral-organ-biopsy-for-companion-animals","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/diagnostics\/visceral-organ-biopsy-for-companion-animals\/","title":{"rendered":"Visceral Organ Biopsy for Companion Animals"},"content":{"rendered":"

Abstract<\/strong><\/p>\n

Visceral organ biopsy is an important diagnostic tool that can be performed as a planned procedure or when an abnormality is incidentally found during abdominal exploratory surgery. Organs that are commonly biopsied include the liver, gastrointestinal tract, and lymph nodes. Most commonly, samples are submitted for histopathology, but, in some cases, culture with antimicrobial susceptibility or other specialized testing may be indicated.<\/p>\n

Take-Home Points<\/strong><\/p>\n

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  • Visceral organ biopsy is a readily available diagnostic tool that can be combined with abdominal exploratory surgery.<\/li>\n
  • Adequate exposure, delicate tissue handling, and good surgical technique facilitate diagnostic sampling and minimize complications.<\/li>\n
  • Biopsies are most commonly performed of the liver, gastrointestinal tract, and lymph node.<\/li>\n
  • Obtaining multiple biopsy samples can improve diagnostic accuracy for diffuse disease processes commonly found in the liver and small intestine.<\/div><\/div><\/li>\n<\/ul>\n

    Visceral biopsy is an important diagnostic tool that may also provide prognostic information when less invasive diagnostics fail to provide needed information or are not adequate for obtaining a definitive diagnosis. It can be a planned procedure based on persistent clinical signs, physical examination findings, blood analysis abnormalities, and\/or imaging findings. Alternatively, abdominal exploratory surgery performed for unrelated reasons may reveal abnormalities that necessitate visceral biopsy. <\/span><\/p>\n

    A variety of approaches and techniques have been described for obtaining biopsies depending on underlying clinical signs, affected organs, and the stability of the patient. In some cases, biopsies can be performed in a less invasive manner with image-guided percutaneous biopsy samples, endoscopy, or laparoscopy; however, the quality of the sample may be limited, or the equipment required to obtain the biopsy may not be readily available.1-6<\/sup> One readily available approach is a laparotomy with a diagnostic abdominal exploration followed by visceral biopsy tailored to the needs of the patient. <\/span><\/p>\n

    Instrumentation<\/h2>\n

    A few key pieces of instrumentation are beneficial when visceral biopsies are performed during laparotomy:<\/span><\/p>\n

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    • A self-retaining abdominal retractor<\/b> such as a Balfour retractor or a Lone Star retractor laterally retracts the sides of the body wall, improving exposure and visualization of abdominal organs.<\/li>\n
    • DeBakey thumb forceps<\/b> have fine teeth and are less traumatic compared with Adson-Brown thumb forceps. Delicate handling of visceral organs and biopsy samples is essential to obtain diagnostic samples in a complication-free manner.<\/li>\n
    • A pair of atraumatic Doyen intestinal clamps<\/b> can be beneficial when performing intestinal biopsy. They are designed to be clamped across the intestine to prevent contamination of ingesta while the small bowel is opened.<\/li>\n<\/ul>\n

      Abdominal Exploration<\/h2>\n

      Visual examination along with palpation of visceral organs helps identify abnormalities and determine which organs should be biopsied. There is no standardized way to perform an abdominal exploration, but the surgeon should be systematic, similar to the approach used for a physical examination, to ensure that all structures have been assessed. A midline laparotomy beginning just caudal to the xiphoid and extending toward the pubis is performed to allow for a thorough exploration (<\/span>VIDEO\u00a01<\/b><\/span>). The falciform ligament can be excised to improve visualization within the cranial abdomen. A Balfour self-retaining retractor is placed and laparotomy sponges and\/or huck towels are placed along either side to protect the viscera from the skin. The diaphragm is visualized and all portions of the liver, biliary tree, and stomach are palpated. Retraction of the descending duodenum to the patient\u2019s left enables visualization of the right limb of the pancreas, right kidney, caudal vena cava, portal vein, and the right ovary if indicated. The right adrenal gland is closely associated with the caudal vena cava and can be difficult to visualize.<\/span><\/p>\n