Liver biopsy

Overview

A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined in a lab under a microscope for signs of damage or disease. Your healthcare professional may recommend a liver biopsy if blood tests or imaging studies suggest you might have a liver problem. A liver biopsy also is used to find out the state of someone's liver disease. This information helps guide treatment decisions.

The most common type of liver biopsy is called percutaneous liver biopsy. It involves inserting a thin needle through the belly into the liver and removing a small piece of tissue. Another type of liver biopsy involves using a vein in the neck. This type is called a transjugular biopsy. Another type of biopsy involves inserting instruments through a small cut in the belly. This is known as the laparoscopic method.

Why it's done

A liver biopsy may be done to:

• Look for the cause of a liver problem that can't be found with a healthcare professional's exam, blood tests or imaging studies.
• Get a sample of tissue from an irregularity found by an imaging study.
• Find out how bad liver disease is, a process called staging.
• Help create treatment plans based on the liver's condition.
• Find out how well treatment for liver disease is working.
• Check on the liver after a liver transplant.

Your healthcare professional may recommend a liver biopsy if you have:

• Irregular liver test results that can't be explained.
• A tumor or other irregularities on your liver as seen on imaging tests.

A liver biopsy also is most often done to help diagnose and stage certain liver diseases, including:

• Nonalcoholic fatty liver disease.
• Chronic hepatitis B or C.
• Autoimmune hepatitis.
• Liver cirrhosis.
• Primary biliary cholangitis.
• Primary sclerosing cholangitis.
• Hemochromatosis.
• Wilson's disease.

Risks

A liver biopsy is a safe procedure when done by an experienced healthcare professional. Possible risks include:

• Pain. Pain at the biopsy site is the most common complication after a liver biopsy. Pain after a liver biopsy is usually mild. You may be given pain medicine, such as acetaminophen (Tylenol, others), to help manage the pain. Sometimes a narcotic pain medicine, such as acetaminophen with codeine, may be prescribed.
• Bleeding. Bleeding can happen after a liver biopsy but is not common. If there is too much bleeding, you may need to be hospitalized for a blood transfusion or surgery to stop the bleeding.
• Infection. Rarely, bacteria may enter the stomach cavity or blood.
• Accidental injury to a nearby organ. In rare instances, the needle may stick another internal organ, such as the gallbladder or a lung, during a liver biopsy.

In a transjugular procedure, a thin tube is inserted through a large vein in the neck and passed down into the vein that runs through the liver. If you have a transjugular liver biopsy, other rare risks include:

• Collection of blood in the neck. Blood may pool around the site where the tube was inserted, possibly causing pain and swelling. The collection of blood is called a hematoma.
• Short-term problems with the facial nerves. Rarely, the transjugular procedure can injure nerves and affect the face and eyes, causing short-term problems, such as a drooping eyelid.
• Short-term voice problems. You may be hoarse, have a weak voice or lose your voice for a short time.
• Puncture of the lung. If the needle accidentally sticks your lung, the result may be a collapsed lung, called pneumothorax.

How you prepare

Before your liver biopsy, you'll meet with your healthcare professional to talk about what to expect during the biopsy. This is a good time to ask questions about the procedure and make sure you understand the risks and advantages.

Food and medications

When you meet with your healthcare professional, bring a list of all medicines you take, including medicines available without a prescription, vitamins and herbal supplements. Before your liver biopsy, you'll probably be asked to stop taking medicines and supplements that can raise the risk of bleeding, including:

• Aspirin, ibuprofen (Advil, Motrin IB, others) and certain other pain relievers.
• Blood-thinning medications, also called anticoagulants, such as warfarin.
• Certain dietary supplements that may raise the risk of bleeding.

You may be asked not to drink or eat for 6 to 8 hours before the liver biopsy. Some people can eat a light breakfast.

Pre-biopsy blood tests

Before your biopsy, you'll have a blood test to check your blood's ability to clot. If you have blood-clotting problems, you may be given a medicine before your biopsy to lower the risk of bleeding.

Arrangements for your recovery

You may receive a medicine to help you relax, called a sedative, before your liver biopsy. If this is the case, arrange for someone to drive you home after the procedure. Have someone stay with you or check on you during the first night. Many healthcare professionals recommend that people spend the first evening within an hour's driving distance of the hospital where the biopsy is done. This is in case a complication happens.

What you can expect

What you can expect during your liver biopsy will depend on the type of procedure you have. A percutaneous liver biopsy is the most common type of liver biopsy, but it isn't a choice for everyone. Your healthcare professional may recommend a different type of liver biopsy if you:

• Could have trouble holding still during the procedure.
• Have a history of or are likely to have bleeding problems or a blood-clotting illness.
• Might have a tumor involving blood vessels in your liver.
• Have a lot of fluid in your stomach, called ascites.
• Are very obese.
• Have a liver infection.

During the procedure

A liver biopsy takes place at a hospital or outpatient center. You'll probably arrive early in the morning.

Just before your biopsy, you will:

• Have a line placed in a vein, usually in your arm, so that you can be given medicines if you need them.
• Possibly be given a medicine to help you relax during the procedure.
• Use the toilet if needed because you'll need to stay in bed for a few hours after the procedure.

The steps involved in liver biopsy are different according to the type:

• Percutaneous biopsy. To begin your procedure, your healthcare professional locates your liver by tapping on your stomach or using ultrasound images. In some situations, ultrasound might be used during the biopsy to guide the needle into your liver. You lie on your back and position your right hand above your head on the table.

  Your healthcare professional spreads a numbing medication on the area where the needle will be inserted. The healthcare professional then makes a small cut near the bottom of your rib cage on your right side and inserts the biopsy needle. The biopsy itself takes just a few seconds. As the needle passes quickly in and out of your liver, you'll be asked to hold your breath.

• Transjugular biopsy. You lie on your back on an X-ray table. Your healthcare professional spreads a numbing medicine on one side of your neck. Then a small cut is made, and a flexible plastic tube is inserted into your jugular vein. The tube is threaded down the jugular vein and into the large vein in your liver, called the hepatic vein.

  Your healthcare professional then injects a dye into the tube and makes several X-ray images. The dye shows up on the images, allowing the healthcare professional to see the hepatic vein. A biopsy needle is then threaded through the tube, and one or more liver samples are taken. The catheter is carefully taken out, and the cut on your neck is covered with a bandage.

• Laparoscopic biopsy. During a laparoscopic biopsy, you'll probably receive medicine that puts you to sleep. You lie on your back on an operating table, and your healthcare professional makes one or more small cuts in your stomach during the procedure.

  Special tools are inserted through the cuts, including a tiny video camera that projects images on a monitor in the operating room. The professional uses the video images to guide the tools to the liver to take tissue samples. The tools are taken out, and the cuts are closed with stitches.

After the procedure

After the biopsy, you can expect to:

• Be taken to a recovery room, where a nurse will watch your blood pressure, pulse and breathing.
• Rest quietly for 2 to 4 hours, or longer if you had a transjugular procedure.
• Feel some soreness where the needle was inserted, which may last as long as a week.
• Have someone drive you home, since you won't be able to drive until the medicine to make you feel calm wears off.
• Avoid lifting more than 10 to 15 pounds for one week.
• Be able to get back to your usual activities gradually over a period of a week.

Results

Your liver tissue goes to a laboratory to be examined by a healthcare professional who specializes in diagnosing disease, called a pathologist. The pathologist looks for signs of disease and damage to the liver. The biopsy report comes back from the pathology lab within a few days to a week.

At a follow-up visit, your healthcare professional will explain the results. The source of your symptoms may be a liver disease. Or your healthcare professional may give your liver disease a stage or grade number based on how bad it is. Stages or grades are usually mild, moderate or severe. Your healthcare professional will discuss what treatment, if any, you need.

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