Liver biopsy

A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease. Your health care provider 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 abdominal incision. This is known as the laparoscopic method.

A liver biopsy may be done to:

• Diagnose a liver problem that can't be otherwise identified with a health care provider's exam, blood tests or imaging studies.
• Obtain a sample of tissue from an irregularity found by an imaging study.
• Determine the severity of liver disease, a process called staging.
• Help develop treatment plans based on the liver's condition.
• Determine how well treatment for liver disease is working.
• Monitor the liver after a liver transplant.

Your health care provider 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 commonly performed 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.

A liver biopsy is a safe procedure when performed by an experienced health care provider. 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 a mild discomfort. 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 occur after a liver biopsy but is not a common complication. Too much bleeding may require you to be hospitalized for a blood transfusion or surgery to stop the bleeding.
• Infection. Rarely, bacteria may enter the abdominal cavity or bloodstream.
• 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 infrequent risks include:

• Collection of blood in the neck. Blood may pool around the site where the catheter was inserted, potentially causing pain and swelling. The collection of blood is called a hematoma.
• Temporary 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.
• Temporary 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.

Before your liver biopsy, you'll meet with your provider 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 benefits.

Food and medications

When you meet with your provider, bring a list of all medicines you take, including nonprescription medicines, vitamins and herbal supplements. Before your liver biopsy, you'll likely be asked to stop taking medicines and supplements that can increase 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 increase 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 reduce the risk of bleeding.

Arrangements for your recovery

You may receive a medication 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 providers 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 develops.

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 an option for everyone. Your provider may recommend a different type of liver biopsy if you:

• Could have trouble holding still during the procedure.
• Have a history of or likelihood of bleeding problems or blood-clotting disorders.
• Might have a tumor involving blood vessels in your liver.
• Have a lot of fluid in your abdomen, 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 likely arrive early in the morning.

Just before your biopsy, you will:

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

The steps involved in liver biopsy vary according to the type:

• Percutaneous biopsy. To begin your procedure, your provider locates your liver by tapping on your abdomen or using ultrasound images. In certain 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 provider applies a numbing medication to the area where the needle will be inserted. The provider then makes a small incision 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 provider applies a numbing medicine to one side of your neck. Then a small incision 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 provider then injects a contrast dye into the tube and makes a series of X-ray images. The dye shows up on the images, allowing the provider to see the hepatic vein. A biopsy needle is then threaded through the tube, and one or more liver samples are removed. The catheter is carefully removed, and the incision on your neck is covered with a bandage.

• Laparoscopic biopsy. During a laparoscopic biopsy, you'll likely receive general anesthetics. You lie on your back on an operating table, and your provider makes one or more small incisions in your abdomen during the procedure.

  Special tools are inserted through the incisions, including a tiny video camera that projects images on a monitor in the operating room. The provider uses the video images to guide the tools to the liver to remove tissue samples. The tools are removed, and the incisions are closed with stitches.

After the procedure

After the biopsy, you can expect to:

• Be taken to a recovery room, where a nurse will monitor 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 sedative 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.

Your liver tissue goes to a laboratory to be examined by a provider 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 provider will explain the results. Your diagnosis may be a liver disease. Or your provider may give your liver disease a stage or grade number based on the severity. Stages or grades are usually mild, moderate or severe. Your provider will discuss what treatment, if any, you need.