What is a liver biopsy?
A liver biopsy is a procedure in which a small needle is inserted into the liver to collect a very small sample. The liver sample is then analyzed in a laboratory to help doctors diagnose diseases or disorders in the liver.
What does the liver do?
The liver is located in the right upper side of the abdomen, behind the lower part of the rib cage. The liver is the largest solid organ in the body. It performs many functions, including:
- Making proteins that help with blood clotting, carrying oxygen and helping the immune system.
- Detoxifying the body from harmful substances in the bloodstream, including drugs and alcohol.
- Breaking down saturated fat and producing cholesterol.
- Storing nutrients and returning them to the bloodstream.
- Manufacturing bile, a substance needed to help digest food.
- Helping the body store sugar (glucose) in the form of glycogen.
Why is a liver biopsy performed?
A liver biopsy is often performed to determine how much damage the liver has sustained by assessing the stage of fibrosis (thickening or scarring). (Fibrosis has four stages; F1, F2, F3 and F4.)
A liver biopsy can also be performed to help identify the cause of:
How is a liver biopsy performed?
Liver biopsies are performed in one of three ways:
- Percutaneous: The doctor inserts a needle through the abdominal wall or in the spaces between the lower ribs on the right side to reach the liver.
- Transvenous: The biopsy needle is inserted through a blood vessel in the neck called the jugular vein, then a catheter is advanced all the way down to the liver to take the sample. This procedure is done when the patient has problems with blood clotting, has a great deal of fluid in the abdomen, or when pressure measurement in the liver is required.
- Laparoscopic: The doctor inserts a laparoscope, a narrow tube with a camera, through an incision in the side of the body. The doctor will then place a needle through a thin tube (cannula) to obtain the liver sample. This method is mostly used when the patient is having a laparoscopic procedure for another condition, and is rarely used for liver biopsy alone.
Your doctor can discuss with you whether the percutaneous or transvenous approach is more suitable for your case.
How do I prepare for a liver biopsy?
Before the biopsy:
- Tell your doctor if you are pregnant, have a lung or heart condition, are allergic to any medications or have any bleeding problems.
- Tell your doctor about all the medications you are taking. It is especially important to tell your doctor if you are taking blood-thinning medications such as warfarin (Coumadin®), clopidogrel (Plavix®), dipyridamole (Persantine®), or ticlopidine (Ticlid®).
- For the week before the procedure, do not take aspirin, products containing aspirin or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil®, Motrin®, Aleve®), naproxen (Naprosyn®) or indomethacin (Indocin®).
Do not discontinue any medication without first checking with your primary care or referring doctor.
Your doctor will order laboratory tests to be done 2-7 days before the procedure. These tests include a blood count, a platelet count and a measurement of your blood's ability to clot.
What happens on the day of the liver biopsy?
Before the procedure:
- Don’t eat or drink anything for 4-6 hours before the procedure.
- A doctor will explain the biopsy procedure in detail, including possible complications, and answer any questions you may have.
- You will put on a hospital gown.
- You will receive a small dose of a sedative before the procedure to help you relax. Therefore, it is very important to have a family member or a friend with you on the day of the procedure to take you home.
During the percutaneous liver biopsy procedure:
- You will lie on your back, with your right elbow out to the side and your right hand above your head. It is important that you remain as still as possible during the procedure.
- An ultrasound will be used to mark the location of your liver.
- The doctor will clean and then numb the area on your upper abdomen with a local anesthetic (pain-relieving medication). The doctor then makes a very small (less than 5 mm) incision (cut) on your upper abdomen and inserts a needle into this incision to take a small sample of liver tissue for analysis.
During the transvenous liver biopsy procedure:
- You will lie on your back. It is important that you remain as still as possible during the procedure.
- The doctor numbs the side of your neck and makes a very small (less than 5 mm) incision. The doctor then inserts a cannula into the incision and advances it to the liver, followed by a needle to take the biopsy of the liver.
After the biopsy:
- You will stay in a recovery room for up to 4 hours for observation.
- You may feel minor discomfort or a dull pain in your upper abdomen, right shoulder or back. If necessary, a pain medication will be prescribed for you.
- Do not drive or operate machinery for at least 12 hours after the procedure.
- Do not take aspirin, products containing aspirin, or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil®, Motrin®, Aleve®), naproxen (Naprosyn®) or indomethacin (Indocin®) for 3-5 days after the procedure. You may take acetaminophen (Tylenol) if needed.
- Do not perform vigorous physical activity for at least 24 hours after the biopsy.
- Your doctor will discuss the biopsy results with you when they come in.
What are the possible risks of a liver biopsy?
- Pain: You might feel pain at the site of the biopsy. You could also feel pain in the back or the right shoulder.
- Bleeding: Minor bleeding might happen at the biopsy site or inside the abdomen around the liver. Major bleeding is rare, but if it happens, you may have to be admitted to the hospital.
- Infection: Infection rarely develops at the site of the biopsy or in the bloodstream.
- Injury to organs around the liver: Other organs around the liver, like the gallbladder, lung or small bowel, could accidentally be injured during the biopsy.
Results and Follow-Up
When should I call my doctor after a liver biopsy?
In most instances, there are no complications in performing a liver biopsy. However, internal bleeding may rarely occur, as well as a leak of bile from the liver or gallbladder.
Please call your doctor or go to the nearest emergency room if you have any of the following: