A biopsy is a procedure in which a small sample of tissue is removed from a part of your body. The sample is looked at under a microscope, or tested in other ways. A liver biopsy is a common procedure when a small sample of liver tissue is removed. A liver biopsy is done to diagnose and monitor certain conditions of your liver. For example, cirrhosis, some metabolic liver disorders, or inflammation of the liver (hepatitis) which can be due to various causes. You will be asked to lie on a couch on your back, or on your left side. The skin over your liver is cleaned with antiseptic. Your liver lies under your ribs and your main breathing muscle (the diaphragm), on the upper right-hand side of your tummy (abdomen). Some local anaesthetic is then injected into a small area of skin and tissues just over a part of your liver (usually between two lower ribs on the right-hand side). This stings a little at first, but then makes your skin in this area numb. A special hollow needle is then pushed through your skin into your liver. You will have to hold your breath for 5-10 seconds when the needle is quickly pushed in and out (you will be told exactly when). This is because the liver moves slightly when you breathe in and out. As the needle comes out it brings with it a small sample of liver tissue. The doctor who does the biopsy may use an ultrasound scanner or computerised tomography (CT) scan for guidance. The scan locates the exact site of your liver so the biopsy needle is inserted at exactly the right place. The scan is painless. In some people it is not possible to carry out the procedure in the way described above. Some conditions affect your liver's ability to make substances that help blood clot. If you have one of these conditions there is more chance of bleeding after the biopsy. Using a different procedure to take the biopsy can reduce the risk of bleeding in these people. Usually this involves inserting a very thin, hollow tube (a catheter) into a vein in your neck or groin. The skin will be made numb by a local anaesthetic before the procedure. The catheter is then gently guided to the veins inside your liver. A small needle on the tip of the catheter makes a tiny hole in the wall of the vein. The needle collects a sample of liver tissue which is then retained in the catheter as it is taken out of your body. This second procedure has less chance of causing bleeding if you have problems with blood clotting. In people with no clotting problems, the first method is normally used. Your hospital will advise you which method will be used to take the biopsy. Another type of liver biopsy is a laparoscopic liver biopsy which is undertaken at the time of surgery for another indication - eg, gallbladder removal. There is no special preparation for this procedure apart from what you should do for the surgery itself. Another method for performing a liver biopsy is via a camera (endoscopy). An endoscopic ultrasound scan uses an endoscope with an ultrasound probe attached to create detailed pictures of internal organs and structures. This is a new technique which is not available in all hospitals. Does a liver biopsy hurt?Because of the local anaesthetic, you should not feel any pain. However, you may feel some mild discomfort or pressure as the doctor pushes on the needle. Any pain or discomfort you experience is usually eased with painkillers. You will usually have a blood test done shortly before the biopsy, to check how well your blood will clot. This is to make sure that you are not likely to bleed following the biopsy. You may be advised not to take any medicines that affect blood clotting, such as aspirin and warfarin, for one week before the biopsy. (You will usually be advised to take your other medication as normal before the biopsy. However, you may need to discuss this with your doctor.) You will need to sign a consent form at some point before the procedure to say that you understand what it involves, and the small risk involved. Complications are very uncommon. The most common complication is some mild pain or discomfort in the area where the liver biopsy was taken. In a small number of cases there is some bleeding from the biopsy site. This is usually minor, and soon stops. Occasionally, the bleeding is more severe and (rarely) it requires a blood transfusion and/or an operation to deal with it. The main reason you are monitored for several hours after the biopsy is to check for bleeding. A rare complication is for bile to leak from the liver internally. There is a small risk that the small wound will become infected after the biopsy. You will need to lie on your side on a bed and be observed for several hours to check that you have no bleeding. Therefore, you may wish to bring in a book or a music player for this time. If you come into hospital for the test, you may need to stay in overnight. However, if the biopsy was done early in the morning, you may be able to go home later in the day. Any pain or discomfort you experience is usually eased with painkillers. The result of the biopsy may take a week or so to come back. Your doctor may advise you not to take part in contact sports such as rugby for a certain length of time after the procedure. This is to make sure your liver has a chance to heal properly. You should seek medical advice if:
A liver biopsy is a medical procedure in which a small amount of liver tissue is surgically removed so it can be analyzed in a laboratory. Liver biopsies are usually done to evaluate disease, such as cirrhosis, or to detect infection, inflammation, or cancerous cells. Your doctor may order a liver biopsy if blood or imaging tests indicate there are problems with your liver. The liver is a vital organ. It does many things the body needs to function and survive, such as:
Your doctor may order a liver biopsy to help them determine whether an area is infected, inflamed, or cancerous, or to diagnose the degree of liver damage. Symptoms that a doctor would test for include:
A liver biopsy is usually done if you received abnormal results from other liver tests, have a tumor or mass on your liver, or experience consistent, unexplainable fevers. While imaging tests like CT scans and X-rays can help identify areas of concern, they can’t always give an exact diagnosis or determine the best treatments options. For this, you need a biopsy. Although biopsies are typically associated with cancer, it doesn’t mean you have cancer if your doctor orders this test. Biopsies also allow doctors to see if a condition other than cancer is causing your symptoms. Your doctor can use a liver biopsy to help diagnose or monitor a number of liver disorders. Some conditions that affect the liver and may require a biopsy include: Any medical procedure that involves breaking the skin carries the risk of infection and bleeding. While the incision for a liver biopsy is small, there is still a risk of bleeding since the liver has many blood vessels. According to the National Institute of Diabetes and Digestive and Kidney Diseases, bleeding occurs in 1 in 500 liver biopsies. Severe bleeding occurs in 1 in 2,500 biopsies. In severe cases of bleeding, blood transfusions or surgery may be needed to stop the bleeding. Biopsies don’t require much preparation. Depending on your condition, your doctor may ask you to:
Just before the procedure, you’ll change into a hospital gown. Your doctor will give you a sedative through an intravenous (IV) line to help you relax. There are three basic types of liver biopsies:
The kind of anesthetic your doctor gives you will depend on which type of liver biopsy they perform. The percutaneous and transjugular biopsies use local anesthetics. This means your doctor only numbs the affected area. Laparoscopic biopsies require being under general anesthesia, so you’ll be in a deep sleep during the procedure. When your biopsy is complete, your doctor will close any incision wounds with stitches and bandages. You’ll typically have to lie in bed for a few hours after the procedure while doctors monitor your vital signs. Once you receive approval from your doctor, you are free to go home. Take it easy and rest for the next 24 hours. You should be able to get back to your normal activities after a few days. After the liver tissue sample is taken, it will be sent to a laboratory for testing. This could take up to a few weeks. When the results are back, your doctor will call you or ask you to come in for a follow-up appointment to share the results. Once a diagnosis is reached, your doctor will discuss any recommended treatment plans or next steps with you. |