The liver is a large, football-shaped organ located in the right upper abdomen behind the lower rib cage. There are a variety of problems that can affect the liver such as viruses, alcohol, fat, medications, genetic disorders, liver tumors and autoimmune diseases. Some of these may lead to permanent liver damage. The liver can be evaluated by performing blood tests or imaging via ultrasound, CT or MRI. Sometimes a liver biopsy is needed to obtain additional information about the cause or amount of liver injury.
What is a liver biopsy?
A liver biopsy is a procedure in which a small sample of liver tissue is obtained. The tissue is then processed in the laboratory where it is analyzed under the microscope. Even though it is a small sample of the liver (about a one inch thin strand), the biopsy can provide information about the whole liver.
What should I expect the day of my procedure?
Before a liver biopsy is done, blood tests are obtained to check a patient’s clotting factors. Adequate clotting of the blood is important to minimize the risk of bleeding after the biopsy. A patient is instructed to completely avoid aspirin or arthritis-type medications that may thin the blood such as Aleve, Motrin, Ibuprofen and Advil for at least 5 days prior to the procedure. If a patient is on other blood thinners such as Coumadin or Plavix additional instructions may be needed after consulting with the patient’s physicians. Physicians have different preferences in terms of fasting or not fasting prior to the biopsy. Please check with your physician prior to having a liver biopsy for specific instructions. If you are unclear as to your instructions, please call our office.
A liver biopsy is usually performed as an outpatient in a hospital by either a gastroenterologist or radiologist. The procedure is generally done in the radiology department. The patient lies on a stretcher, ultrasound is used to find an appropriate place for the biopsy, the skin is cleaned and then local numbing medication is used. Following this a tiny incision is made in the skin so that the small needle can pass easily into the liver. The liver biopsy is done by passing a small needle quickly into and out of the liver for approximately one second while the patient holds their breath. Infrequently the biopsy needle needs to be passed again in order to obtain an adequate sample. Stitches are not necessary and a bandage is placed over the biopsy site. Patients are generally monitored for about 4 hours after the biopsy with frequent vital signs. For the first two hours of recovery patients generally lie on their right side to apply pressure to the biopsy site. For the remainder of the monitoring period patients generally lie in bed with the head of the bed raised. During this time a patient may eat.
What are the possible complications of a liver biopsy?
Overall a liver biopsy is a safe procedure. Infrequently patients may experience brief discomfort or pain at the biopsy site or the right shoulder. Internal bleeding is a rare complication that can occur in less than 1% of patients. If this happens patients may require blood transfusions or surgery. An infrequent complication is accidentally puncturing organs adjacent to the liver such as the gallbladder, lungs, kidney and intestine. Also bile can rarely leak from the liver biopsy site or gallbladder and cause peritonitis.
Are there any restrictions after the biopsy?
Generally patients should plan to take it easy the day of the biopsy. Patients cannot drive the day of the biopsy particularly if any sedating medications were used for the procedure. Aspirin or other arthritis-type medications that may thin the blood need to be avoided for an additional 5 days after the biopsy to allow the site to heal. Lifting objects heavier than 20 pounds should be avoided for 5 days following the biopsy.
When are the biopsy results available?
The liver tissue is processed in the laboratory where slides are made and evaluated under the microscope by the pathologist. The results are usually available within one week of the procedure. Results are discussed with the patient by phone or during a follow-up clinic visit, depending on your physician’s preference.
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