Liver Biopsy

Liver biopsy

The liver is a pyramid-shaped organ that lies within the upper right side of the abdomen. In a typical liver biopsy , a needle is inserted through the rib cage or abdominal wall . The needle goes into the liver to take a sample for examination.

The procedure can also be performed by inserting a needle into the jugular vein . A catheter is then passed through the veins, down to the liver, to take the sample.

Preparation

Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. 

You must not eat or drink anything for 8 hours before the biopsy, and you should plan t oarrive at the hospital about an hour before the scheduled time of the procedure.

Be sure t oinform your doctor of any medicl conditions you have or medications you take on a regular basis such as

• aspirin
• arthritis medications
• blood thinners
• diabetes medication

One week before the procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants.  Your physician will tell you whether to take your regular medicatons during the fasting period and may give you other special instructions.

The medical staff will also want to know if you have heart disease, lung disease, or any medical condition that may need special attention.  You must also arrange for someone to take you home afterward, because you will not be allowed to drive after being sedated.

Procedure

Liver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot.

You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.

What happens after a liver biopsy?

After the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for 1 to 2 hours. The nurse will monitor your vital signs and level of pain.

You will need to arrange for someone to take you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for 8 to 12 hours, depending on your physician's instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in your right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after surgery. These medicines decrease blood clotting, which is crucial for healing.

Possible complication of a liver biopsy

Liver biopsy is generally safe and complications are rare when the test is performed by a Board-certified gastrenterologist.

Irritation may occur at the vein where medications were given, sometimes leaving a tender lump lasting several weeks.  Applying hot moist towels may help relieve discomfort. 

Like any surgery, liver biopsy does have some risks, such as puncture of the lung or gallbladder, infection, bleeding, and pain, but these complications are rare.

Other rare risks include a reaction to the sedatives used, aggravation of hesrt or lung diseases, or perforation (a tear that might require surgery to repair).

Please call the Hepatology Department immediately if after the procedure you develop fever, pain, or bleeding.