Liver biopsy

What is a liver biopsy?

A biopsy is a procedure in which a small sample of tissue is removed from a part of the body. The sample is then looked at under a microscope or tested in other ways. A liver biopsy is a common procedure when a small sample of liver tissue is removed.

A liver biopsy is done to diagnose and monitor damage or disease of the liver. This can include cirrhosis, some metabolic liver disorders, or inflammation of the liver (hepatitis) which can be due to various causes.

Diagram showing liver position and biopsy site

You will be asked to lie on a couch on your back, or on your left side. The skin over your liver is cleaned with antiseptic. Your liver lies under your ribs and your main breathing muscle (the diaphragm), on the upper right-hand side of your tummy (abdomen).

Some local anaesthetic is then injected into a small area of skin and tissues just over a part of your liver (usually between two lower ribs on the right-hand side). This stings a little at first, but then makes your skin in this area numb. A special hollow needle is then pushed through your skin into your liver.

You will have to hold your breath for 5-10 seconds when the needle is quickly pushed in and out (you will be told exactly when). This is because the liver moves slightly when you breathe in and out. As the needle comes out it brings with it a small sample of liver tissue.

The doctor who does the biopsy may use an ultrasound scanner or computerised tomography (CT) scan for guidance. The scan locates the exact site of your liver so the biopsy needle is inserted at exactly the right place. The scan is painless.

In some people it is not possible to carry out the procedure in the way described above. Some conditions affect your liver's ability to make substances that help blood clot. If you have one of these conditions there is more chance of bleeding after the biopsy due to a reduced ability for the blood to clot.

Using a different procedure to take the biopsy can reduce the risk of bleeding in these people. Usually this involves inserting a hollow, thin tube (a catheter) into a vein in your neck (jugular vein) or groin. The skin will be made numb by a local anaesthetic before the procedure.

The catheter is then gently guided to the veins inside your liver. A small needle on the tip of the catheter makes a tiny hole in the wall of the vein. The needle collects a sample of liver tissue which is then retained in the catheter as it is taken out of your body.

This second procedure has less chance of causing bleeding if you have problems with blood clotting. In people with no clotting problems, the first method is normally used. Your hospital will advise you which method will be used to take the biopsy.

Another type of liver biopsy is a laparoscopic liver biopsy which is undertaken at the time of surgery for something else - for example, gallbladder removal. There is no special preparation for this procedure apart from what you should do for the surgery itself.

Another method for performing a liver biopsy is via a camera (endoscopy). An endoscopic ultrasound scan uses an endoscope with an ultrasound probe attached to create detailed pictures of internal organs and structures. This is a new technique which is not available in all hospitals.

Does a liver biopsy hurt?

Because of the local anaesthetic, you should not feel any pain. However, you may feel some mild discomfort or pressure as the doctor pushes on the needle. Any pain or discomfort you experience is usually eased with painkillers.

You will usually have a blood test done shortly before the biopsy to check how well your blood will clot. This is to make sure that you are not likely to bleed too much following the biopsy. You may be advised not to take any medicines that affect blood clotting, such as aspirin and warfarin, for one week before the biopsy. (You will usually be advised to take your other medication as normal before the biopsy. However, you may need to discuss this with your hospital doctor.)

You will need to sign a consent form at some point before the procedure to say that you understand what it involves, and the small risk involved.

Complications are very uncommon. The most common complication is some mild pain or discomfort in the area where the liver biopsy was taken.

In a small number of cases there is some bleeding from the biopsy site. This is usually minor and soon stops. Occasionally, the bleeding is more severe and (rarely) it requires a blood transfusion and/or an operation to deal with it. The main reason you are monitored for several hours after the biopsy is to check for bleeding.

A rare complication is for bile to leak from the liver internally. There is a small risk that the small wound will become infected after the biopsy.

You will need to lie on your side on a bed and be observed for several hours to check that you have no bleeding. Therefore, you may wish to bring in a book or a music player for this time. If you come into hospital for the test, you may need to stay in overnight. However, if the biopsy was done early in the morning, you may be able to go home later in the day.

Any pain or discomfort you experience is usually eased with painkillers. The result of the biopsy may take a week or so to come back. Your doctor may advise you not to take part in contact sports such as rugby for a certain length of time after the procedure. This is to make sure your liver has a chance to heal properly.

You should seek medical advice if:

• Bleeding occurs from the biopsy site.

• The biopsy site becomes red, angry looking or swollen.

• You develop a high temperature (fever).

• The biopsy site is still painful three days later and painkillers do not help.