This leaflet is designed to help you understand the procedure
What is a liver biopsy?
In a liver biopsy the doctor will take a very small piece of your liver(1/50,000th of your liver)so that it can examined under the microscope by a pathologist.
Why is this done?
This will help identify the cause of your liver disease as well as guide on amount of liver damage. It can also help identify any infection in the liver.
How is the liver biopsy done?
This is done as a day case procedure,(in the radiology department), usually requiring 6 hrs in hospital. Sometimes admission is needed overnight for observation.
- Before the liver biopsy your doctor will check your blood tests to ensure that clotting is within acceptable limits. Sometimes due to the underlying liver disease, the blood does not clot well and you may require some blood factors(plasma) to help your blood clot.
- You must inform your doctor if you are taking blood You must inform your doctor if you are taking blood thinning medication( thinning medication( warfarinwarfarin, aspirin, , aspirin, clopidogrelclopidogrel, dipyridamole,heparin) or anti-inflammatory painkillers(ibuprofen,diclofenac,naproxen,voltarol,mefenamic acid) as these increase risk of bleeding. If you are on any of these medication ,these will be stopped for
- During the procedure you will lie flat on the bed with your right hand under your head. Using Ultrasound guidance, the site will be confirmed and a disposable liver biopsy needle will be used to obtain the sample. A local anaesthetic will be given to make the skin numb before the procedure. You will be asked to hold your breath for a few seconds when the biopsy is being done.
- After the biopsy:
Immediately following procedure:
- A plaster will be placed on the biopsy site.
- You will asked to lie on the right side for 2 hrs and then lie on your back for at least 4 hours , to help puncture site to heal.
- The nurse will monitor your pulse and blood pressure initially every 15 minutes for first 1-2 hrs and subsequently every half an hour to 1 hr.
- Will it hurt?:Apart from local anaesthetic which may sting for a little while, the procedure should not be painful. You could feel a sensation of pressure during the procedure as anaesthetic cannot be injected inside the liver.There may be pain at the biopsy site after the effect of local anaesthetic wears off. Sometimes pain may radiate to the shoulder tip. You can ask for pain relief as needed.
- You should rest for the remainder of the day after going home
- Can take pain relief medication prescribed by hospital but you should avoid anti-inflammatory pain killers for 2 weeks.
- You should not remove the dressing or make it wet for the first 24 hours. If the dressing is heavily soiled due to excess bleeding kindly contact the hospital.
- Avoid lifting heavy weights for 24 hrs following procedure.
- If there are no complications most patients can return to work the next day. You should avoid contact sports after the procedure for 2 weeks.
- You will have an outpatient appointment arranged to discuss the results of biopsy in a few days.
What are the complications?
- Majority of liver biopsies have no complications.
- The most common complication is pain and this can be controlled with pain killers such as paracetamol and tramadol depending on intensity.
- Bleeding: is a potential problem due to which the doctor checks your blood tests before the biopsy to see if it clots normally. Also the nurse monitors your blood pressure and pulse to identify this immediately following procedure for 6 hrs.following procedure for 6 hrs.
- Bleeding may affect 1 in 200 liver biopsies. This often settles without any intervention, but 1 in 4 of these may require blood transfusion. Very rarely, 1 in 500 cases of those who bleed an operation may be needed to stop bleeding.
- Sometimes the liver biopsy needle can go into another organ , this can happen 1 in 1000 cases but since procedure is done under ultrasound guidance this risk is further reduced.