Liver biopsy

What is the test?

A liver biopsy takes a sample of your liver tissue so that it can be examined under a microscope. Liver biopsy is useful for determining the cause and best treatment of multiple different types of liver condition, including hepatitis and cancer.

How do I prepare for the test?

You will need to sign a consent form giving your doctor permission to perform this test. Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist's office. If you are taking insulin, discuss this with your doctor before the test. If you take aspirin, nonsteroidal anti-inflammatory drugs, vitamin E or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test. You will also have blood tests to find out if you are at extra risk for bleeding after the procedure.

You will be told not to eat or drink anything after midnight the night before the test. This is a safety precaution in case you are one of the rare patients that has a complication that might require surgery on the same day as the procedure.

What happens when the test is performed?

Usually the liver biopsy is done in a special procedure clinic called the endoscopy area of a hospital. You wear a hospital gown. A blood pressure cuff is put on your arm to monitor your blood pressure, and a finger clip is used to measure your blood oxygen level. An IV (intravenous) line is put into your arm or hand in case you need to receive some fluid during the procedure. (You would be likely to need this only if you had a bleeding problem from the test.)

The liver is located just under your ribs on the right side. Your doctor taps on your right rib cage and abdomen to find the edges of your liver. If your liver is on the small side, the doctor might use an ultrasound sensor to see exactly where the top and bottom of the liver are.

Medicine through a small needle is used to numb the skin in one place over your lower ribs. The numbing medicine usually stings for a second. After this, the liver biopsy needle is inserted. The biopsy needle is 5-6 inches long, but it is not put that far inside you. A small piece of liver tissue is captured inside the needle. The needle is pulled out and the sample carefully removed.

Most patients feel some soreness or cramping in their side and right shoulder after this test, but the soreness usually lasts for only 10-15 minutes.

Alternatively, a liver tissue sample can be obtained by a procedure called a transjugular liver biopsy. The doctor inserts a needle into the jugular vein in the neck. A thin flexible tube (catheter) is threaded through the needle and advanced into the liver. The doctor traces the path of the catheter using X-ray or ultrasound guidance.

Once the catheter tip is located within the liver, the doctor inserts a special biopsy needle through the catheter. The biopsy needle goes beyond the catheter tip to take liver samples. The samples come back out through the catheter. This technique is considered slightly safer than the standard liver biopsy technique. However, the tissue samples tend to be smaller and may be more difficult to interpret.

What risks are there from the test?

This test is safe for most patients, but there are some serious complications that can occur. Bleeding can occur from the place where the needle went into the liver. When this occurs, the blood usually stays inside the sac that surrounds the liver and causes this lining to stretch to the point that you feel some pain for a few days. More serious bleeding is rare. If you are one of the patients who has more serious bleeding, there is a chance that you will need surgery to stop the bleeding. Other risks include injury to the lung, intestine, or gallbladder. These rarely occur.

Must I do anything special after the test is over?

After the biopsy, you will need to lie on your right side for a full two hours. This is done so that your weight puts pressure on the liver, reducing the chances of bleeding. You will be watched for four hours after that, with your blood pressure getting checked every now and then to make sure there is no sign that you are bleeding inside. Usually the doctor will allow you to eat and drink during this time.

You should not do any heavy lifting or aerobic exercise for a couple of days, while your liver is healing.

How long is it before the result of the test is known?

Examination of your liver sample by pathology doctors takes close to five days.