Liver Biopsy

A liver biopsy is a procedure in which a small needle is inserted into the liver to collect a tissue sample. This is performed as an office or outpatient procedure or during surgery. The tissue is then analyzed in a laboratory to help doctors diagnose a variety of disorders and diseases in the liver. A liver biopsy is most often performed to help identify the cause of:

• Persistent abnormal liver blood tests (liver enzymes).
• Unexplained yellowing of the skin (jaundice).
• A liver abnormality found on ultrasound, CT scan, or nuclear scan.
• Unexplained enlargement of the liver.

In most instances, there are no complications in obtaining a liver biopsy. However, rarely internal bleeding may occur, as well as a leak of bile from the liver or gallbladder.

When preparing for a liver biopsy, there are several things to keep in mind.

• Tell your doctor if you're pregnant, have a lung or heart condition, are allergic to any medications, or have bleeding problems.
• Tell your doctor if you are taking blood-thinning medications such as Coumadin, Plavix, or Persantine. Your doctor may prescribe an alternate method for thinning your blood before the procedure.
• For the week before the procedure, do not take aspirin, products containing aspirin, or anti-inflammatory drugs (such as ibuprofen, Advil, Motrin, Naprosyn, or Indocin) unless otherwise advised by your doctor.

Do not discontinue any medication without first consulting with your primary or referring doctor.

Laboratory tests will be performed on the day of a liver biopsy or 2-3 days before the procedure, as directed by your doctor. These tests may include a blood count, a platelet count, and a measurement of your blood's ability to clot.

Before the procedure:

• A doctor will explain the biopsy procedure in detail, including possible complications and answer any questions you may have.

During the procedure:

• You will be asked to wear a hospital gown.
• You will lie on your back, with your right elbow out to the side and your right hand under your head. It is important that you remain as still as possible during the procedure.
• An ultrasound may be used to mark the location of your liver.
• You may receive a small dose of a sedative just prior to the procedure.
• The doctor cleans and numbs an area on your upper abdomen with a local anesthetic (pain-relieving medication). The doctor then makes a small incision on your upper abdomen and inserts a needle into this incision to take a small sample of liver tissue for analysis.
• The procedure takes about 5 minutes.

After the procedure:

• You will stay in a recovery room for up to 4 hours for observation.
• You may feel minor discomfort or a dull pain in your shoulders or back. If necessary, a pain medication will be prescribed for you.
• Do not drive or operate machinery for at least eight hours after the procedure.
• Avoid taking aspirin, products containing aspirin, or anti-inflammatory drugs (such as ibuprofen, Advil, Naprosyn, Indocin, or Motrin) for one week after the procedure. You may takeacetaminophen (Tylenol) if needed.
• Do not perform vigorous physical activity for at least 24 hours after the biopsy.
• Your doctor will discuss the biopsy results with you several days after the procedure.

Two other methods of liver biopsy may also be available: laparoscopic and transvenous.

During a laparoscopic biopsy, a laparoscope (a thin lighted tube with a camera attached) is inserted through an incision in the abdomen. The laparoscope sends images of the liver to a monitor that the physician watches while using instruments to remove tissue samples from one or more parts of the liver. This type of biopsy may be used when tissue samples are needed from specific parts of the liver.

A transvenous biopsy may be done when patients have blood-clotting problems or fluid in the abdomen. The physician inserts a tube called a catheter into a vein in the neck and guides it to the liver. A biopsy needle is placed into the catheter and then into the liver to obtain a sample.

If you have a fever; difficulty breathing; chills; dizziness; or tenderness or severe pain at the site of a liver biopsy or in the chest, shoulder, or abdomen within 72 hours after the procedure, please call your doctor or go to the nearest emergency room.