Overview of liver biopsy
A liver biopsy is a procedure in which a small needle is inserted into the liver to collect a sample of tissue. It can be done in the office or in a patient’s procedure or during surgery. The tissue is analyzed in a laboratory to help doctors diagnose a variety of liver disorders and diseases. Liver biopsies are often done to help determine the cause:
- Ongoing abnormal liver blood tests (liver enzymes)
- Indescribable yellowing of the skin (jaundice)
- Hepatic abnormality was detected on ultrasound, computed tomography, or nuclear tomography
- Unexplained enlargement of the liver
Types of liver biopsy
For each type of liver biopsy, doctors take a different type of liver tissue sample. Typical types of liver biopsy are described below.
Percutaneous liver biopsy: In a percutaneous liver biopsy, the doctor inserts a needle through the skin in the upper abdomen to take a small piece of liver tissue. Percutaneous liver biopsy is the most common type of liver biopsy and has been routine for many years.
Your doctor can scan the NIH external link or computed tomography (CT) scan to make sure the needle is in the right place. Illustration of a percutaneous liver biopsy, showing the liver within the human torso, a slide with a needle, and a tissue sample inserted into the abdomen.
Transular liver biopsy: In a transjugular liver biopsy, a doctor inserts a needle into a vein in the neck called the jugular vein. The doctor injects a needle into your liver through your veins to take a small piece of tissue.
Doctors often perform a transgender biopsy on those with more problems with percutaneous liver biopsy. For example, bleeding after a percutaneous biopsy is more likely in people with blood clotting problems NIH external link. Formation of fluid in the abdomen, which is a complication of cirrhosis: Percutaneous biopsy is difficult because the liver is very far from the skin and is difficult to locate.
The transgender biopsy also allows doctors to measure the pressure in the veins of the liver during a biopsy.
Surgical liver biopsy: If you need a liver biopsy and are having surgery for other reasons, your doctor may perform a liver biopsy during surgery.
Why liver biopsy is done?
A liver biopsy may be done to:
- Confirm an undiagnosed liver problem
- Obtain a tissue sample of the abnormality found by imaging
- Determine the severity of the liver disease, a process called staging
- Help develop treatment plans based on the condition of the liver
- Determine how well liver disease treatment works
- Monitor the liver after a liver transplant
Liver biopsy is recommended if you have:
- Unexplained abnormal liver test results
- Mass (tumor) or other abnormalities in your liver as seen on imaging tests
- Ongoing, unexplained fevers
A liver biopsy is usually done to diagnose and stage certain liver diseases:
- Nonalcoholic fatty liver disease
- Chronic hepatitis B or c
- Autoimmune hepatitis
- Alcoholic liver disease
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Wilson disease
Preparation for a liver biopsy
Biopsies do not require much preparation on the part of the patient. Depending on your condition, your doctor may ask you:
- Have a complete medical history and physical exam
- Stop taking medications that affect bleeding, including pain relievers, blood thinners, and some supplements.
- Draw your blood for a blood test
- Do not drink or eat until eight hours before the procedure.
- Arrange for someone to drive you home
You will be in the recovery room for up to 4 hours for observation. You may experience mild pain or discomfort at the biopsy site and ache or a dull ache in your shoulders or back. If necessary, pain relievers may be prescribed.
After the procedure, do not drive or operate any machinery for at least eight hours. Avoid taking aspirin, aspirin-containing products, or anti-inflammatory medications (such as ibuprofen, Advil, naproxen, indosine, or Motrin) for a week after the procedure. You can take acetaminophen (Tylenol) if needed.
Do not engage in vigorous physical activity or lift heavy objects for at least 24 hours and 1 week after the biopsy. Several days after the procedure, your doctor will discuss the biopsy results with you.
Before the liver biopsy
Before the procedure, you put on a hospital gown. Your doctor will give you an intravenous (IV) sedative to help you relax.
The anesthesia your doctor will give you depends on the type of liver biopsy you have. Percutaneous and transgender biopsies use local anesthesia, that is, only the affected area is numbed. Laparoscopic biopsies require general anesthesia, so you can sleep soundly and painlessly during the procedure.
When the biopsy is complete, the incisions will be closed with stitches and properly bandaged. You may need to stay in bed for a few hours after the procedure while doctors check your vital signs.
Once you get permission from your doctor, you can go home. You should take it lightly and rest for the next 24 hours. However, you will be able to return to your normal life after a few days.
After the liver biopsy
You should lie on your side in bed and watch for several hours to check that you are not bleeding. So you may want to bring a book or music player this time. If you come to the hospital for the test, you will have to stay overnight. However, if the biopsy is done in the morning, you can go home later that day.
Any pain or discomfort you experience is usually relieved with pain relievers. The biopsy result can take anywhere from days to a week to come back. Your doctor may recommend that you do not play contact sports such as rugby for some time after this procedure. This is to make sure your liver can heal properly.
You should seek medical advice if:
- Bleeding occurs at the biopsy site
- The biopsy site becomes red, angry, or swollen
- You develop a high fever
- The biopsy site still hurts after three days, and pain medicine doesn’t help
Risks of liver biopsy
Problems are very common. Some mild pain or discomfort in the area where the liver biopsy was taken is a very common problem.
In a small number of cases, there is some bleeding at the biopsy site. It is usually short and will stop soon. Occasionally, the bleeding becomes more severe and (rarely) requires a blood transfusion and/or surgery to treat it.
The main reason you will be monitored for several hours after a biopsy is to check for bleeding. Bile leakage internally from the liver is a very rare problem. There is a risk of minor injury after the biopsy.
What are the other liver biopsy methods?
Laparoscopic and transvenous are two other methods of liver biopsy.
Laparoscopic: During a laparoscopic biopsy, a laparoscope (a thin tube with an incision attached to the camera) is inserted through an incision in the abdomen. The laparoscope sends images of the liver to a doctor’s monitor when equipment is used to remove tissue samples from one or more parts of the liver. This type of biopsy can be used when tissue samples are needed from specific parts of the liver.
Transvenous: A transvenous biopsy may be done when patients have problems with blood or fluid clotting in the abdomen. The doctor inserts a tube called a catheter into a vein in the neck to guide the liver. A biopsy needle can be placed into the catheter, and then a sample can be taken from the liver.