Liver Biopsy

A liver biopsy is a procedure in which a small needle is inserted into the liver to collect a tissue sample. 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

A liver biopsy can also be used to estimate the degree of liver damage, to grade and stage hepatitis B and C, and to determine the best treatment for the damage or disease.

Is Liver Biopsy Safe?

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. There is a slight risk of a pneumothorax, also called a collapsed lung, if the biopsy needle makes a hole in the chest wall causing air to enter.

How Do I Prepare for a Liver Biopsy?

When preparing for a liver biopsy, you should:

• 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 aspirin, Coumadin, Plavix, or Eliquis. Your doctor may prescribe an alternate method for thinning your blood before the procedure.
• Talk with your doctor about the procedure.
• Have any necessary blood tests done.
• Find out how long before the procedure you'll need to stop eating.
• Arrange for a ride home after 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.

What Happens on the Day of a Liver Biopsy?

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:

During the procedure, which takes about 5 minutes:

• 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 will clean and numb an area on your upper abdomen with a local anesthetic (pain-relieving medication). The doctor will then make a small incision on your upper abdomen and insert a needle into this incision to take a small sample of liver tissue for analysis.

After the procedure:

• You will stay in a recovery room for up to 4 hours for observation.
• You may feel minor pain or soreness at the biopsy site and 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 take acetaminophen (Tylenol) if needed.
• Do not perform vigorous physical activity or heavy lifting for at least 24 hours and up to 1 week 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 doctor 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.

Warning About Liver Biopsy

If these symptoms occur within 72 hours of the biopsy, call your doctor or go to the nearest emergency room:

• Fever
• Dizziness
• Chills
• Difficulty breathing
• Chest pain
• Abdominal swelling or bloating
• Increasing abdominal pain
• Tenderness or severe pain or redness at the site of the biopsy or in the shoulder, chest, or abdomen

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