Acute right upper quadrant pain: A lesson in odds

Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 20892, USA.
Digestive and Liver Disease (Impact Factor: 2.96). 07/2009; 42(1):72-3. DOI: 10.1016/j.dld.2009.05.004
Source: PubMed
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    New England Journal of Medicine 03/2001; 344(7):495-500. DOI:10.1056/NEJM200102153440706 · 55.87 Impact Factor
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    ABSTRACT: During nine years 3,080 liver biopsies were carried out and bleeding occurred in 22 of the patients (0.7 percent). Transfusions were given to 17 of these patients and laparotomies were done to control the bleeding in six. All survived. Bleeding was evident within three hours in 19 patients, but occurred from 3 to 13 days after biopsy in the remaining three. Pain requiring analgesic medication and a fall in blood pressure were the usual indications that major bleeding had occurred. Relative contraindications to biopsy (particularly a prolonged prothrombin time) were present in 10 of the 22 bleeding patients and in only 2 of the 41 nonbleeding controls (P<0.001). We believe that some of the bleeding episodes could have been prevented with more careful attention to the indications and contraindications to biopsy, and more rigorous correction of recognized clotting abnormalities.
    Western Journal of Medicine 02/1981; 134(1):11-4.
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    ABSTRACT: This paper reviews the complications that arose after 68 276 percutaneous liver biopsies performed from 1973 to 1983. The complications are analyzed in relation to the underlying liver disease and to the type of needle used. Death was infrequent (9/100 000); it was always due to haemoperitoneum and occurred only in patients with malignant diseases or cirrhosis. Complications were less frequent in AVH (44/100 000) than in other liver diseases (from 125 to 278/100 000). Death, serious haemorrhagic complications, pneumothorax and biliary peritonitis were more frequent after biopsy with the Trucut needle than after biopsy with Menghini's needle (3/1000 against 1/1000).Sixty-one percent of complications were discovered within two hours of biopsy and 96% within one day. The data indicate a post biopsy observation period of at least 24 hours. The day-case procedure should be reserved for patients not presenting liver tumour or cirrhosis.
    Journal of Hepatology 02/1986; 2(2-2):165-173. DOI:10.1016/S0168-8278(86)80075-7 · 11.34 Impact Factor


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