Liver Biopsy

A procedure to remove a small piece of liver tissue is called liver biopsy. This is suggested if you have a liver problem according to your blood tests or imaging studies.

The sample of your liver tissue will be sent to the laboratory to be examined under a microscope to check for signs of disease or damage.

This will also determine how severe the liver disease is so that this information can help your doctor with treatment decisions.

Percutaneous liver biopsy is the most common type of liver biopsy and this is done by inserting a thin needle through your abdomen into the liver so your doctor can remove a small tissue for the sample.

The laparoscopic liver biopsy involves a small abdominal incision while transjugular liver biopsy uses a vein in your neck. Both of these remove tissue by the use of a needle.

Here are the most common reasons to undergo a liver biopsy.

A liver biopsy is an option to:

• obtain a sample of tissue from an abnormality found by an imaging study
• diagnose a liver problem that cannot be otherwise identified
• help develop treatment plans depending on the condition of the liver
• determine the severity of the liver disease which is called staging
• monitor the liver after a liver transplant
• determine how well treatment for liver disease is working

Your doctor will suggest liver biopsy if you have:

• a tumor or mass or other abnormalities on your liver as seen on imaging tests
• abnormal liver test results that cannot be explained
• an ongoing and unexplained fevers

A liver biopsy is done to diagnose certain liver diseases including:

• chronic hepatitis B or C
• nonalcoholic fatty liver disease
• alcoholic liver disease
• autoimmune hepatitis
• primary sclerosing cholangitis
• primary biliary cirrhosis
• Wilson's disease
• hemochromatosis

Liver biopsy should be done by an experienced doctor for safety.

The possible risks include:

Bleeding – this can happen after the biopsy and you might be hospitalized to have a blood transfusion or surgery if there is excessive bleeding.

Pain – this is the most common complication after a liver biopsy which you can feel at the liver biopsy site. You can ask your doctor for a pain medication if you cannot handle the pain and these drugs might be acetaminophen with codeine (Tylenol with Codeine).

Accidental injury to a nearby organ – the needle might stick on another internal organ such as the lung or gallbladder.

Infection – sometimes bacteria may enter the bloodstream or abdominal cavity. A thin tube is inserted into a large vein in your neck and passed down into the vein that runs through your liver in a transjugular procedure.

If you have a transjugular liver biopsy some of the risks include:

Hematoma or collection of blood in the neck – this may cause swelling and pain due to a pool of blood around the site where the catheter was inserted.

Temporary voice problems – for a short time your voice might become hoarse, have a weak voice or lose your voice.

Temporary problems with the facial nerves – you may experience drooping eyelid because it can injure nerves and affect the face and eyes, but this is very rare.

Puncture of the lung – you might have pneumothorax if the needle accidentally sticks your lung.

In order to prepare for the procedure, you and your doctor will discuss what to expect before and during the biopsy.

You can ask any questions that are bothering you and make sure you understand the risks and benefits.

You will have a blood test first to check your blood's ability to clot. Your doctor might give you medication before your biopsy to reduce the risk of bleeding if you have blood-clotting problems.

He will ask you not to eat and drink anything 8 hours before the procedure or he may allow you to have a light breakfast.

Bring a list of all medications you take, including over-the-counter medications, vitamins, and herbal supplements on your appointment with your doctor.

Before the procedure, he may ask you to stop taking medications and supplements that can increase the risk of bleeding such as:

• blood-thinning medications or anticoagulants such as warfarin (Coumadin)
• aspirin such as ibuprofen (Advil, Motrin IB) and certain pain relievers
• certain dietary supplements that may increase the risk of uncontrolled bleeding

Before the liver biopsy, your doctor may give you a sedative so someone should stay with you the whole time of the procedure.

Here’s what you can expect before, during, and after your liver biopsy.

The most common type of liver biopsy is percutaneous liver biopsy but this procedure is not an option for everyone.

Your doctor may suggest a different form of liver biopsy if you:

• have a history of bleeding problems or blood-clotting disorders
• could have trouble holding still during the procedure
• have ascites meaning you there is an abnormal amount of fluid in your abdomen
• may have a tumor involving blood vessels in your liver
• have a liver infection, and are very obese

This is done at the hospital and the medical team will review your medical history.

Before the biopsy you will:

• possibly given a sedative to help you relax during the procedure
• have an IV line placed mostly into a vein in your arm so that you can be given medications if you need them
• use the toilet if needed because you'll need to remain in bed for a few hours after the procedure

The steps involved in liver biopsy vary according to the type:

Percutaneous biopsy – by using ultrasound images or tapping on your abdomen, your doctor will locate your liver. Sometimes to guide the needle into your liver, your doctor might use ultrasound.

He will ask you to lie on your back and position your right hand above your head on the table and he will put a numbing medication to the area where the needle will be inserted.

He can now make a small cut near the bottom of your rib cage on your right side and inserts the biopsy needle. He will ask you to hold your breath while the needle passes quickly in and out of your liver. This procedure can be done in about a few seconds.

Transjugular biopsy – your doctor will ask you to lie down on a table while he applies a numbing medication on your neck so he can make a small cut and then inserts a plastic tube.

The tube will then fasten down your jugular vein into your hepatic vein. Your doctor will do a series of X-ray images by injecting a contrast dye into the tube. He will then remove liver samples by threading a biopsy needle through the tube.

Laparoscopic biopsy – Your doctor will ask you to lie back on a table while he gives you anesthesia, and then makes tiny cuts in your abdomen.

To remove tissue samples, your doctor will use medical tools such as a tiny video camera so it can project images on a monitor. He will close the stitches after the tools were removed.

After the procedure:

• your doctor and other medical staff will monitor your breathing, pulse and blood pressure
• take a rest for a short period of time;may feel a little pain on the injected site
• you may ask a family member or a close friend to drive you home
• your doctor will tell you not to lift heavy things for a week or two
• will be able to do your daily activities within a week or two

Understanding the results of your liver biopsy procedure will be made possible by your doctor.

A pathologist who specializes in diagnosing disease will check the liver tissue sample which is sent to the laboratory. He will check for signs of disease and damage to the liver.

You will get the results from the pathology lab after a few days to a week. After getting the report, your doctor will explain and discuss with you the results.

You might be diagnosed with a liver disease or your liver disease may be given a stage or grade number based on the severity such as mild, moderate or severe.

If you need any treatment, your doctor will discuss them with you.