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Liver Biopsy

USUAL QUESTIONS

What is a liver biopsy?

A liver biopsy is a procedure used to obtain a very small piece of liver tissue so that doctors can examine the liver tissue under a microscope to arrive at the correct diagnosis. When other tests indicate that your liver may not be working properly, your doctor may want to do a liver biopsy to more accurately learn the condition of your liver.

What are the situations/intentions whereby a liver doctor orders biopsy?

A liver biopsy is ordered for,

  1. Diagnose liver disease and the stage/grade/severity/extent and pattern of damage.
  2. Diagnose cancer if the same is not unequivocally done with a CT scan or MRI scan.
  3. Find out the cause of liver swelling (Chronic Hepatitis) or abnormal levels of liver enzymes.

What do you expect on the day of biopsy?

Before the biopsy, your doctor will take blood samples to make sure your blood clots properly. You will not be able to eat or drink anything for eight hours before the test. After the procedure you will be requested to be in bed for 4-5 hours for monitoring. You may feel a bit of soreness at the needle site and sometimes over the right shoulder. Liver biopsy can be done as a day case and in select situations on inpatient basis. Liver biopsy does have some risks but they are not common. Risks include internal bleeding, injury to the lung, gallbladder. In experienced liver units these complications are rare and if at all they occur, remedial measures can be employed.

It is important to tell your doctor:

  1. All the medications (prescription, non-prescription, supplements) you are taking.
  2. Bleeding problems you may have.
  3. Allergies you may have.
  4. Any other medical illness you have.
  5. If you are pregnant.
  6. If you are on blood thinners, modifications in the same prior to the biopsy will have to be done.

What are the different techniques of performing a liver biopsy?

There are three ways of performing a liver biopsy.

  1. Conventional percutaneous biopsy
    This is done by inserting a needle through right upper part of your abdomen. You will be asked to lie on your back with your right hand above your head. After injecting a local anesthetic on the intended site of needle puncture to make you pain free, doctor will make a small cut in your right side near your rib cage and insert a needle to get a tiny sample of your liver tissue. An ultrasound image of your liver may be used in the process to help guide the needle into the liver. You will be requested to hold breath and stay still when needle is inserted. You will be given additional pain medications as injections.The entire procedure lasts about twenty minutes.
  2. Laparoscopic (Key hole)
    Your doctor will insert a tube fitted with camera called a laparoscope through a small cut in your abdomen. Through laparoscope your doctor can see the liver directly. Lapraroscope sends live pictures of your liver to a screen. Your doctor watches the screen and passes instruments through the laparoscope to obtain tiny tissue samples from your liver. The laparoscopic method is used in situations where tissue samples from a specific part of your liver has to be obtained (Liver tumor).
  3. Transvenous (TJLB- TransJugular intrahepatic portosystemic shunt)
    Your doctor will insert a tube called a catheter into a vein in your neck and pas it into your liver. The doctor puts a biopsy needle into the catheter into your liver to take tiny tissue samples. The transvenous method is used if you have blood clotting problems or have fluid in your abdomen. In these situations a conventional biopsy through right side of your abdomen may not be safe.

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