Definition

Liver biopsy is a procedure to obtain a sample of your liver tissue. This test is done through a small incision using a special biopsy needle. Liver biopsy is usually an outpatient procedure.


Parts of the Body Involved

  • Abdomen
  • Chest
  • Vein in neck

Reasons for Procedure

Biopsies of the liver are usually performed to evaluate:

  • Abnormal blood tests (elevated liver enzymes, elevated copper or iron in the blood)
  • An enlarged liver
  • The severity of liver diseases
  • The progress of therapy for liver diseases
  • A liver mass
  • The liver after liver transplantation
  • Fever, when the cause of the fever is not known

Risk Factors for Complications During the Procedure

  • Bleeding disorder
  • Kidney failure [3]
  • Ascites (fluid in the abdomen)
  • Inability to lie still

What to Expect

Prior to Procedure

Before your biopsy, your doctor will ask you to:

  • Not eat or drink for 8 to 12 hours
  • Not take certain blood-thinning medications for up to a week
  • Arrange to stay near a hospital for 24 hours after the procedure
  • Arrange for someone to drive you home (if you get a sedative for the procedure)

At the time of your biopsy, your doctor will do some, or all, of the following:

  • Conduct a complete physical exam
  • Order blood tests
  • Perform an ultrasound
  • Give you a blood product transfusion, if needed

Anesthesia

  • You may get a mild intravenous (IV) sedative to relax you
  • You will get a local anesthetic medication injected where the biopsy needle will pass

Description of the Procedure

Conventional Liver Biopsy

Your doctor will need your help during the procedure. For the procedure, you will lie on your back with your right hand behind your head. Your doctor might do an ultrasound [4] or CT scan [5] of your liver to guide placement of the biopsy needle.

Your doctor will clean your skin with antiseptic soap or iodine. Next, your doctor will inject medication into the skin to make it numb.

After your skin is numb, your doctor will make a small incision. Your doctor will ask you to exhale and hold your breath while he or she inserts the biopsy needle into your liver. Sometimes, your doctor will need to insert the biopsy needle more than once. It is important to hold very still during the procedure.

After the procedure, your doctor will bandage your incision. Then you will need to lie on your right side for at least two hours.

Placement of Liver Biopsy Needle

Placement of Liver Biopsy Needle

© 2008 Nucleus Medical Art, Inc.

Laparoscopic Liver Biopsy

When biopsies are required from very specific areas of the liver, a laparoscopic procedure is used. In this procedure, your doctor will make a tiny incision and pass a scope (laparoscope) into your abdomen in the area of the liver. The scope will send images of the liver to a screen for your doctor to view. Your doctor will pass instruments through the scope to retrieve samples of your liver.

Transvenous Liver Biopsy

Your doctor may use this approach if your blood clots poorly or you have a lot of fluid in your abdomen. In this procedure, your doctor will thread a tiny flexible tube (known as a catheter) into a vein in your neck or groin, and all the way into the veins in your liver. Your doctor will pass a biopsy needle through the catheter to obtain biopsy samples.

After Procedure

The liver tissue will be sent to a laboratory for analysis.

How Long Will It Take?

The liver biopsy will take 15 to 20 minutes. After the procedure, you will lie on your right side for at least two hours.

You will stay in the hospital longer if sedation medications are given.

Will It Hurt?

The numbing medication will burn for a few seconds. After the procedure, you will have mild pain [6] or cramping at the biopsy site. Pain in the right shoulder is also possible. The pain [6] should last for less than 30 minutes.

Possible Complications

  • Pain (common)
  • Bleeding (uncommon)
  • Infection (rare)
  • Perforation of the gallbladder or intestines (rare)
  • Pneumothorax [7] —puncture of the lung (rare)
  • Death (very rare)

Average Hospital Stay

A liver biopsy is typically an outpatient procedure. There is no required hospital stay.

Postoperative Care

  • If a sedative was given, do not drive for at least 24 hours.
  • Rest the remainder of the day.
  • Do not exercise [8] or lift heavy objects for at least a week. Check with your doctor about when you can resume normal exertion.
  • Resume your normal diet, unless told otherwise by your doctor.
  • Resume your medications, unless told otherwise by your doctor.
  • Ask your doctor when it is safe to resume anticoagulation medications (such as ibuprofen, aspirin, or warfarin).

Outcome

The results from your biopsy will take 1 to 4 weeks. You and your doctor will discuss the results. Based on the biopsy results, it may be necessary to change your medications or start new medications.


Call Your Doctor If Any of the Following Occurs

  • Signs of infection, such as fevers or chills
  • A faint or light-headed feeling
  • Severe abdominal pain [6], nausea, or vomiting
  • Cough, shortness of breath, or chest pain [6]
  • Bleeding or drainage from the needle puncture site