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

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


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. 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


All three main types of liver biopsy 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

Percutaneous Liver Biopsy

The most commonly used technique for collecting a liver sample is percutaneous liver biopsy. For this method, a hollow needle is inserted through the abdomen into the liver to remove a small piece of tissue
During the procedure, patients lie on their back on a table with their right hand resting above their head. A local anesthetic is applied to the area where the biopsy needle will be inserted. If needed, an IV tube is used to give sedatives and pain medication

The doctor makes a small incision in the abdomen, either toward the bottom of the rib cage or just below it, and inserts the biopsy needle. Patients will be asked to exhale and hold their breath while the needle is inserted and a liver sample is quickly withdrawn. Several samples may be collected, requiring multiple needle insertions

After the biopsy, patients must lie on their right side for up to 2 hours to reduce the risk of bleeding. Patients are then monitored an additional 2 to 4 hours after the biopsy before being sent home

Transvenous Liver Biopsy

Transvenous liver biopsy is used when a person’s blood clots slowly or when excess fl uid is present in the abdomen, a condition called ascites

During the procedure, patients lie on their back on an x-ray table and a local anesthetic is applied to one side of the neck. If needed, an IV tube is used to give sedatives and pain medication

A small incision is made in the neck and a specially designed hollow tube called a sheath is inserted into the jugular vein. The doctor threads the sheath down the jugular vein, along the side of the heart, and into one of the hepatic veins, which are located in the liver. To see the veins, the doctor injects liquid contrast material into the sheath. The contrast material lights up when x rayed, highlighting the blood vessels and showing the location of the sheath

The doctor threads a biopsy needle through the sheath and into the liver and a liver sample is quickly withdrawn. Several samples may be collected, requiring multiple needle insertions. The sheath is carefully withdrawn and the incision is closed with a bandage

Patients are monitored for 4 to 6 hours for signs of bleeding

Laparoscopic Liver
Biopsy

Doctors use laparoscopic liver biopsy to obtain a tissue sample from a specific area or from multiple areas of the liver or when the risk of spreading cancer or infection exists

Laparoscopic surgery is a technique that avoids making a large incision by instead making one or a few small incisions. The doctor works with special tools—including a small, lighted video camera—passed through the incisions

A doctor may take a liver sample during laparoscopic surgery performed for other reasons, including liver surgery

During laparoscopy, patients lie on their back on an operating table. An IV is inserted in a vein to give sedatives and pain medication. A small incision is made in the abdomen, usually just below the rib cage. A plastic, tubelike instrument, called a cannula, is inserted in the incision and the abdomen is inflated with gas. Inflation allows the doctor space to work inside the abdominal cavity

A biopsy needle is inserted through the cannula and into the abdomen. The needle is inserted into the liver and a tissue sample is quickly withdrawn. Several samples may be collected, requiring multiple needle insertions. Any excessive bleeding because of the surgery is easily spotted with the camera and treated using an electric probe

After liver samples are collected, the cannula is removed and the incision is closed with dissolvable stitches

Patients will need to remain at the hospital or outpatient center for a few hours while the sedatives wear off

Points to Remember

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

A liver biopsy is used to diagnose liver problems or to estimate the degree of liver damage

Patients prepare for a liver biopsy by stopping medications that might interfere with blood clotting and by having blood drawn to make sure clotting is normal. Patients who will be sedated should not eat or drink for 8 hours before the liver biopsy and should arrange a ride home

All three main types of liver biopsy remove liver tissue with a needle; however, each uses a different approach to inserting the needle into the liver

Results from a liver biopsy take a few days to come back

Most patients fully recover from a liver biopsy in 1 to 2 days

The major risk of liver biopsy is excessive bleeding, called hemorrhage