With a liver biopsy (BYE-op-see), the physician is able to examine a small piece of tissue from your liver for signs of damage or disease. This procedure involves using a special needle to remove tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x-ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy.
Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those, like blood thinners, that affect blood clotting. One week before the surgery, you will have to stop taking aspirin, ibuprofen, and anticoagulants. You will also have a chest x-ray.
You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the surgery. Your physician will tell you whether to take your normal medications during the fasting period and may give you other special instructions.
Liver biopsy is considered minor surgery and is done at the hospital. The nurse will start an intravenous line to give you medication for the procedure. For the biopsy, you will lie on a hospital bed on your back or turned slightly to the left side, 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 a dull pain. The entire procedure takes about 20 minutes.
Two other methods of liver biopsy are also available. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples from one or more parts of the liver. Physicians use this type of biopsy when they need tissue samples from specific parts of the liver.
Transvenous biopsy involves inserting a tube called a catheter into a vein in the neck and guiding it to the liver. The physician puts a biopsy needle into the catheter and then into the liver. Physicians use this procedure when patients have blood-clotting problems or fluid in the abdomen.
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 at least 2 hours. The nurse will monitor your vital signs and level of pain. You may remain in the hospital for up to 24 hours after the surgery to recover from the sedative and to allow the medical staff to check you for complications before sending you home.
You will need to arrange to have someone 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, be sure not to exert yourself too much for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site, and you might have 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.
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.