A liver biopsy is a diagnostic procedure used to examine liver tissue and determine the cause of any abnormalities. This procedure is often performed after another test, such as a blood test or imaging test, indicates a problem with the liver. A liver biopsy can diagnose many problems, including cirrhosis, hepatitis B or C, and liver cancer. Results from a liver biopsy are available within a few days to several weeks.
Reasons for a Liver Biopsy
A liver biopsy is performed when other diagnostic tests, such as blood tests and imaging techniques, show a problem with the liver. When these tests are inconclusive or when more detailed diagnostic information is needed, a liver biopsy is necessary. It is imperative to diagnose diseases or malfunctions of the liver because the liver is a vital organ with several serious purposes. The liver aids in digestion, stores nutrients and vitamins, fights infection, and acts as a filter to remove harmful chemicals from the blood. A liver biopsy may:
- Find the cause of jaundice
- Diagnose certain liver diseases, such as cirrhosis, or infections, such as hepatitis
- Discover liver tumors
- Check the response to treatment of liver disease
- Determine whether certain potent medications are having a toxic effect on the liver
- Check on the functioning of a transplanted liver
- Diagnose the cause of an unexplained fever
- Estimate the degree of liver damage, a process called staging
Types of Liver Biopsy
There are several ways a biopsy may be performed; all involve the use of a needle to extract tissue samples, and all take a relatively short time, usually less than an hour. The patient is sedated and/or anesthetized and pain medication is administered as necessary. In all of these procedures, several samples of liver tissue may be removed.
Percutaneous Liver Biopsy
In this commonly used technique, a hollow needle is inserted through the abdominal wall to extract a small piece of tissue. Ultrasound, a CT scan or other imaging techniques are often used by the surgeon for guidance during the procedure.
Transvenous Liver Biopsy
This type of biopsy is performed when there is a complicating factor, such as excess fluid in the abdomen, called ascites, or when the patient's blood clots slowly. During a transvenous liver biopsy, an incision is made into the neck, and a hollow tube, or sheath, is inserted into the jugular vein. The physician threads the sheath through the jugular vein, past the heart, and into one of the hepatic veins. Contrast dye is added so that the blood vessels and the sheath can be easily located by the doctor performing the procedure.
Laparoscopic Liver Biopsy
Laparoscopic biopsies are performed when multiple areas of the liver must be examined, or when there is a risk of spreading cancer or infection. During such a biopsy, several small incisions, rather than one large one, are made, and the doctor works with special small tools, including a miniature lighted camera.
Risks of Liver Biopsy
A liver biopsy is a safe procedure and serious problems are rare. Every surgical procedure, however, carries with it some element of risk. The most common problem reported after the procedure is pain at the incision site. Possible complications of a liver biopsy, though rare, may include:
- Excessive bleeding, possible requiring transfusion or surgery
- Spreading of cancer cells
- Pneumothorax, or collapsed lung
- Injury to adjacent organs, such as the gallbladder
- Peritonitis, an infection in the abdomen
- Adverse reaction to anesthesia, medication or contrast dye
Recovery from Liver Biopsy
Most patients fully recover from a liver biopsy in a day or two. Patients should avoid strenuous activity or heavy lifting during this time. Soreness around the incision site may persist for about a week. Patients are usually advised to take over-the-counter painkillers that do not cause bleeding, such as acetaminophen, as needed during recovery.