Liver Biopsy By: Dr Arun Aggarwal Gastroenterologist

The liver is a large organ that is located in the right upper abdomen beneath the rib cage. It performs many functions that are essential to life.

A liver biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. Liver biopsy may be recommended to diagnose a problem or determine the severity of liver disease. The most common reason to obtain a liver biopsy is to determine if there is scar tissue in the liver (and if there is, how much) in a person with chronic liver disease.

REASONS FOR LIVER BIOPSY —

●Nonalcoholic fatty liver disease (NAFLD): NAFLD is a condition in which there are increased amounts of fat in the liver. A liver biopsy may be done to confirm the diagnosis of NAFLD or to see how severely the liver is damaged.

●Certain liver diseases, such as chronic hepatitis B or C, primary biliary cholangitis (also known as primary biliary cirrhosis), primary sclerosing cholangitis, autoimmune hepatitis, hemochromatosis, or Wilson's disease. A biopsy can provide information about how severely the liver is damaged.

●Unexplained liver disease or abnormal liver function tests (blood tests that reflect injury to the liver).

●Evaluation of a mass seen on an imaging test like an ultrasound, CT scan, or MRI.

●Monitoring the liver following a liver transplant.

LIVER BIOPSY PREPARATIONS — Prior to a liver biopsy, a gastroenterologist/ hepatologist will check blood tests that reflect how well your blood clots. Normal blood clotting is important to prevent bleeding after the biopsy.

You should carry a list of your medications, including over-the-counter medications, herbs, and vitamins. Discuss this list with your clinician before the biopsy to see if you need to stop any medications, herbs, or vitamins temporarily.

Medications to avoid before liver biopsy — Patients are usually advised not to take medications that can increase the risk of bleeding. These include the following:

●Aspirin or aspirin-containing medicines.

●Other nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen and naproxen. Many non-prescription medicines contain NSAIDs, so check the labels or ask your pharmacist for help.

●Medicines used to prevent blood clots, such as warfarin (Coumadin).

●Certain medicines for heart conditions (such as abciximab [Reopro], dipyridamole [Persantine], ticlopidine [Ticlid], and clopidogrel [Plavix]).

●Some herbal therapies (such as fish oil or ginkgo biloba).

Do not stop any medications without first talking with your clinician.

Testing before liver biopsy — It is common to have an ultrasound of the liver and gallbladder area before the biopsy so that your doctor can pinpoint the biopsy site.

Eating before liver biopsy — You should have nothing to eat or drink for six hours before the procedure.

LIVER BIOPSY PROCEDURE —  You will have an IV line placed into a vein so that fluid and medicine can be given if needed. You may be given medicines to minimize discomfort and anxiety.

The biopsy itself only takes a few seconds as the biopsy needle is passed quickly in and out of the liver. A small bandage will be applied to the biopsy site; stitches are not needed.

LIVER BIOPSY COMPLICATIONS — A liver biopsy is a very safe procedure when performed by an experienced doctor. The most common problems include mild pain and a minor decrease in blood pressure. More serious complications, such as bleeding, infection, and injury to nearby organs, are very rare.

CARE AFTER LIVER BIOPSY — Following the liver biopsy, you will be asked to lie on your right side, and a nurse will monitor your blood pressure and pulse periodically.

In addition to resting the day of the biopsy, you should plan to take it easy for the next five to seven days. In general, you should not lift more than 15 to 20 pounds for a week, avoid blood-thinning medication for several days, and call with any concerning symptoms, including the following:

●Severe pain at the biopsy site or shoulder

●Shortness of breath

●Chest pain

●Bleeding from the biopsy site

●Fever (temperature greater than 100.4°F or 38°C)

●Abdominal pain

●Weakness, sweating

●Heart palpitations

●Blood in your stool or black, tarry stool