Patient education: Liver biopsy (The Basics)

What is a liver biopsy? — This is a procedure that checks an abnormal area of the liver. The liver is a big organ in the upper right side of the belly (figure 1).

Your doctor might do a liver biopsy to diagnose a problem, monitor a known problem, or learn more about your liver. Some common reasons for a liver biopsy include:

●To check for certain liver diseases such as hepatitis

●To check for fibrosis, which is thickening or scarring of the liver

●If you have unexplained illness, liver disease, or abnormal liver blood tests

●To learn more about a growth or tumor

●To check the liver after a liver transplant

How do I prepare for a liver biopsy? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests to check how well your blood clots

●Ultrasound of the liver and gallbladder – An ultrasound is an imaging test that lets doctors see inside the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●If you need to stop taking any medicines before your procedure. In some cases, the doctor will have you stop taking certain medicines for a time before the biopsy. Follow your doctor's instructions carefully to know which medicines are safe to take and which you should avoid. Examples of medicines you might need to stop include:

•Aspirin or aspirin-containing medicines

•Other nonsteroidal antiinflammatory drugs ("NSAIDs") such as ibuprofen (sample brand names: Motrin, Advil) or naproxen (sample brand name: Aleve). Many non-prescription medicines contain NSAIDs, so check the labels or ask your pharmacist for help.

•Medicines used to prevent blood clots, such as warfarin (brand name: Jantoven)

•Certain medicines for heart conditions, such as clopidogrel (brand name: Plavix)

•Certain supplements, such as fish oil or ginkgo biloba

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the biopsy. This means not eating or drinking anything for a period of time.

In some cases, the doctor will ask you to have a light breakfast such as tea or coffee and toast. They might also ask you to eat a small amount of fat (such as butter or margarine) with breakfast. The fat helps empty your gallbladder. The gallbladder is a small organ that is tucked under your liver. If it is empty, this lowers the risk that it will be injured during the biopsy.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a liver biopsy? — This depends on the type of biopsy you have. The choice is based on:

●Your health

●The size and location of the abnormal area

●What the abnormal area looks like on ultrasound or other imaging test

When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●You will get an injection (shot) to numb the area. You might also get other medicines to help you relax and be more comfortable.

●The 3 main types of biopsies are:

•Fine-needle biopsy – The doctor cleans and numbs the skin on the upper right side of your belly below the ribs. They might use an ultrasound to guide them as they insert a needle to do the biopsy. They use the needle to remove a small amount of tissue from the abnormal area of the liver. Then, they remove the needle and hold pressure to stop any bleeding.

•Transjugular biopsy – This is most often done in people who are at a high risk of bleeding. The doctor places a thin tube called a "catheter" into a vein in the neck. Then, they use fluoroscopy (moving X-rays) to push the catheter to a vein that drains blood from the liver. The doctor inserts a special needle through the catheter to take tissue samples of the liver. Then, they remove the needle and catheter and hold pressure to stop any bleeding.

•Surgical biopsy – This is done in an operating room under general anesthesia. General anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. The doctor makes a cut (incision) in your belly and takes a sample of the abnormal tissue from the liver. Then, they close the incision.

●You might feel pressure when the doctor takes the biopsy, but it should not be painful.

●The doctor will cover the area with clean bandages.

What happens after a liver biopsy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might need to lie on your right side for 2 to 4 hours after the biopsy. Most people can go home later the same day.

Usually, your biopsy results are available within a few days to a week.

What are the risks of a liver biopsy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Pain

●Bleeding

●Infection

●Injury to nearby organs

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