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Liver Biopsy

 

What is a liver biopsy?
 

A liver biopsy is a procedure to remove a small piece of the liver so it can be examined with a microscope for signs of damage or disease. The three main types of liver biopsy are percutaneous, transvenous, and laparoscopic.

 

What is the liver?
 

The liver is a vital organ with many important functions.

The liver

  • removes harmful chemicals from the blood
  • fights infection
  • helps digest food
  • stores nutrients and vitamins
  • stores energy

 

When is a liver biopsy performed?

 

A liver biopsy is performed when a liver problem is difficult to diagnose with blood tests or imaging techniques, such as ultrasound and x ray. More often, a liver biopsy is performed to estimate the degree of liver damage—a process called staging. Staging helps guide treatment.

Drawing of the digestive tract with the esophagus, stomach, liver, small intestine, and large intestine labeled.

 

How does a person prepare for a liver biopsy?
 

At least 1 week before a scheduled liver biopsy, patients should inform their doctor of all medications they are taking. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are sometimes given during a liver biopsy.
 

Medications that may be restricted before and after a liver biopsy include

  • nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen
  • blood thinners
  • high blood pressure medication
  • diabetes medications
  • antidepressants
  • antibiotics
  • asthma medications
  • dietary supplements

 

Prior to liver biopsy, blood will be drawn to determine its ability to clot. People with severe liver disease often have blood clotting problems that can increase the risk of bleeding after the procedure. A medicine given just before a liver biopsy, called clotting factor concentrates, reduces the risk of bleeding in patients with blood clotting abnormalities.
 

Patients who will be sedated should not eat or drink for 8 hours before the liver biopsy and should arrange a ride home, as driving is prohibited for 12 hours after the procedure. Mild sedation is sometimes used during liver biopsy to help patients stay relaxed. Unlike general anesthesia where patients are unconscious, patients can communicate while sedated but then often have no memory of the procedure. Sedatives are often given through an intravenous (IV) tube placed in a vein. The IV can also be used to give pain medication, if necessary, after the procedure.

 

How is a liver biopsy performed?
 

There are three main types of liver biopsy; all of which remove liver tissue with a needle. However, each takes a different approach to needle insertion. A liver biopsy may be performed at a hospital or outpatient center.

Drawing of a percutaneous liver biopsy. A biopsy needle is shown being inserted in a man's liver, and the liver is labeled. An arrow points away from the liver to a microscope slide that has on it a wire-shaped piece of tissue. The caption below the slide reads, “A small piece of tissue is removed with a biopsy needle and looked at with a microscope.”

 

How soon do results come back from a liver biopsy?
 

Results from a liver biopsy take a few days to come back. The liver sample goes to a pathology laboratory where the tissue is stained. Staining highlights important details within the liver tissue and helps the pathologist—a doctor who specializes in diagnosing disease—identify signs of liver disease. The pathologist looks at the tissue with a microscope and sends a report to the patient's doctor.

 

How long does it take to recover from a liver biopsy?
 

Most patients fully recover from a liver biopsy in 1 to 2 days. Patients should avoid intense activity, exercise, or heavy lifting during this time. Soreness around the incision site may persist for about a week. Acetaminophen (Tylenol) or other pain medications that do not interfere with blood clotting may help. Patients should check with their doctor before taking any pain medications.

 

What are the risks of liver biopsy?
 

Pain at the biopsy site is the most frequent risk of percutaneous liver biopsy, occurring in about 20 percent of patients. The risk of excessive bleeding, called hemorrhage, is about 1 in 500 to 1 in 1,000. Risk of death is about 1 in 10,000 to 1 in 12,000. If hemorrhage occurs, a procedure called embolization, assisted by an x-ray procedure used to visualize blood vessels called angiography, can be used to stop the bleeding. In some cases, a blood transfusion is necessary. Surgery can also be used to stop a hemorrhage. Other risks include puncture of other internal organs, infection, and spread of cancer cells, called cancer seeding. Transvenous liver biopsy carries an additional risk of adverse reaction to the contrast material.