Liver Biopsy

(Biopsy-Liver, Percutaneous Liver Biopsy)

Procedure overview

What is a liver biopsy?

A liver biopsy is a procedure in which tissue samples from the liver are removed for examination under a microscope to look for signs of damage or disease. It is used to diagnose many liver conditions. During a liver biopsy, tissue samples are removed with a special needle to determine if cancer or other abnormal cells are present, or to determine how well the liver is working.

There are three types of liver biopsies:

• Percutaneous or needle biopsy. After a local anesthetic is given, the doctor inserts the special biopsy needle into the liver to obtain a sample. Ultrasonography or fluoroscopy (a type of X-ray “movie”) may be used to guide the biopsy needle insertion. Most liver biopsies are performed using this technique.
• Laparoscopic or open biopsy. After a general anesthetic is given, the doctor makes an incision in the skin and surgically removes a piece of the liver. Depending upon the lab findings, further surgery may be performed.
• Transvenous biopsy. After a local anesthetic is given, the doctor makes an incision into a vein on one side of the neck and inserts a specially designed hollow tube called a sheath through the vein down to the liver. One or more tissue samples are removed through the tube.

If your doctor wants to sample a specific area of the liver, the biopsy may be performed in the radiology department, guided by ultrasound (high-frequency sound waves), magnetic resonance imaging (MRI, a combination of large magnets, radiofrequencies, and a computer), or computed tomography (CT scan, a combination of X-rays and computer technology).

Other related procedures that may be used to diagnose liver problems include abdominal X-rays, CT scan of the liver, liver scan, and abdominal ultrasound. Please see these procedures for additional information.

Anatomy of the liver

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The liver is the largest organ in the body. It is located in the upper right side of the abdomen, beneath the diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ.

The liver holds about one pint (13 percent) of the body's blood supply at any given moment. The liver consists of two main lobes, each made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct transports the bile (fluid that helps break down fats and gets rid of wastes in the body) produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine).

The liver carries out many important functions, such as:

• Making bile. This is fluid that helps break down fats and gets rid of wastes in the body.
• Changing food into energy
• Clearing the blood of drugs and other poisonous substances
• Producing certain proteins for blood plasma
• Regulating blood clotting
• Storing vitamins and other nutrients
• Fighting infection

Reasons for the procedure

A liver biopsy is useful to diagnose conditions of the liver that cannot be determined by symptoms or lab tests. When a person has an enlarged liver, jaundice (yellowing of the skin and eyes due to bile pigments in the blood), or abnormal lab tests that suggest liver disease, a biopsy may be done.

A liver biopsy may be performed to diagnose:

• Hepatitis. This is inflammation of the liver that sometimes causes permanent damage, resulting from viruses, drugs, alcohol, or parasites
• Alcoholic liver disease
• Liver tumor. An abnormal lump or mass of tissue. Tumors can be benign (noncancerous) or malignant (cancerous).
• Fatty liver. A buildup of fat in liver cells
• Fibrosis of the liver. This is the growth of scar tissue due to infection, inflammation, injury, or even healing.

There may be other reasons for your doctor to recommend a liver biopsy.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• Discomfort and bruising at the biopsy site
• Prolonged bleeding from the biopsy site, externally or internally
• Infection near the biopsy site
• Puncture of adjacent organs or structures

If the liver biopsy is performed with the aid of X-ray technology, the amount of radiation used is considered minimal. Therefore, the risk for radiation exposure is low.

Liver biopsy may be contraindicated in persons with conditions that affect the blood’s ability to clot, severe ascites (fluid accumulation in the abdomen), or infection of the biliary tract or in the area of the abdomen around the liver.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
• You may be asked not to eat or drink anything before the procedure, generally after midnight. Your doctor will give you specific instructions.
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A liver needle biopsy may be performed on an outpatient basis or as part of your stay in a hospital. The liver biopsy may be performed in a procedure room, in a hospital bed, or in the radiology department. Procedures may vary depending on your condition and your doctor’s practices.

Generally, a percutaneous (through the skin) liver biopsy follows this process:

1. You will be asked to remove your clothing and given a gown to wear.
2. You will be asked to empty your bladder before the biopsy.
3. An intravenous (IV) line may be started in your arm or hand.
4. You will be positioned on your back with your right arm above your head, or on your left side.
5. The doctor will locate your liver by pressing on your abdomen and will mark the location where the biopsy will be done. Ultrasound, MRI, or CT scan may be used to locate a specific spot in the liver.
6. The skin over your liver will be cleansed with an antiseptic solution.
7. You will feel a needle stick when the local anesthetic is injected. This may cause a brief stinging sensation.
8. You will be asked to breathe in, then breathe out and not breathe in again until the doctor inserts the biopsy needle into the liver. Holding your breath while exhaling  prevents movement of the chest wall and diaphragm, which may interfere with the placement of the biopsy needle. You should lie quietly without moving.
9. A needle will be introduced through the skin and into the liver very quickly. It is common to feel pressure as the needle is pressed into the liver, or discomfort in your shoulder due to irritation of the adjacent phrenic nerve.
10. The sample of liver tissue will be removed.
11. There may be more than one puncture performed if the doctor needs more than one tissue sample. If so, the same puncture process will be repeated.
12. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site until the bleeding has stopped.
13. A sterile bandage or will be applied.
14. The liver tissue sample will be sent to the lab for examination.

After the procedure

Your recovery process will vary depending on the type of procedure performed and your doctor’s practices. You may be taken to the recovery room for observation if your procedure was done in a procedure room or in the radiology department. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to a hospital room or discharged to your home.

You will be asked to rest quietly, lying on your right side, in order to apply pressure to the biopsy site for one to two hours. Depending on your condition and your doctor’s preferences, you may be instructed to continue bedrest for an additional four to 24 hours.

A blood sample may be taken a few hours after the procedure to monitor possible internal blood loss.

If you are discharged home within a few hours after the procedure, you may be asked to continue bedrest for a specified period of time once you are at home.

Leave the bandage in place for as long as instructed (usually until the next day).

You will be instructed to avoid strenuous activity, such as heavy lifting for several days up to a week or longer. You should not cough hard or strain for several hours after the procedure.

The biopsy site may be tender or sore for several days after the liver biopsy. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

• Fever and/or chills
• Redness, swelling, warmth, or bleeding or other drainage from the biopsy site
• Increased pain around the biopsy site or elsewhere
• Shortness of breath and/or difficulty breathing

You may resume your normal diet unless instructed differently.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.