In a liver biopsy, the doctor will take a very small piece of your liver (about 1/50,000th of your liver) to send for further tests. Most liver biopsies are examined under the microscope by a pathologist. Sometimes, a piece of liver is sent to microbiology to see if there is any infection in the liver. Your doctor will explain to you why he/she thinks you need a liver biopsy. A liver biopsy may be done to look for the cause of liver abnormalities, to assess if, and how much, the liver is damaged and/or to help in planning treatment.
Are there are any alternatives to a liver biopsy?
There is no other procedure that will give your doctor the same information as a liver biopsy. A biopsy can be done through the side (percutaneous) or, if there are problems with the blood’s ability to clot, through a long needle inserted through a small cut in the neck and, under X-ray, guidance, passed into the liver.
How is the liver biopsy done?
You will need to be in hospital for at least 4-6 hours after the biopsy. This may require admission either overnight or may be done as a day case. Before the liver biopsy is done, the doctor or nurse will check your blood to make sure that clotting is within acceptable limits. If you are taking certain medicines, drugs or tablets that may affect bleeding and clotting you may be asked to stop them for a few days or a week or two before the biopsy. Sometimes, perhaps because of liver disease, the blood does not clot as well as is needed and you may be given some blood factors (plasma) to help your blood clot. Sometimes you may also need platelets to be given. If it is unsafe the doctor will not proceed with the biopsy.
If you are nervous, do ask the doctor about having sedation before the biopsy. Please let us know about this as early as possible because injected sedation is not always available. In order to give injected sedation, an extra nurse or doctor needs to be present to give you the injection and monitor you during the procedure therefore telling us in advance will help us plan for this. You may also be able to take a ‘relaxing’ tablet by mouth before the procedure, if we know to prescribe it in advance.
You will be asked to give written consent to the biopsy before it is carried out. Please do not hesitate to ask the doctor if you have any questions at all.
Most biopsies are now done with ultrasound so you will be taken to the Imaging department on your bed or trolley. During the biopsy, you will have to lie flat on your bed or trolley. The ultrasound will be used to show the doctor exactly where your liver is and the best place for the biopsy. The liver is normally situated on your right side just under the lower ribs. Biopsy is often taken here or in the front at the top of your tummy. The doctor will explain the procedure to you before doing the actual biopsy.
The doctor will put some disinfectant on your skin and then inject a local anesthetic. This may sting before the skin goes numb. You may also feel the local anesthetic deeper inside before it works. It takes a few minutes to have its full effect.
The doctor will then take the biopsy. This usually takes only a few seconds. You will be asked to hold your breath for a few seconds while it is being done. Sometimes we need to take 2 or 3 samples to be sure to have enough to analyse.
When the biopsy is done, a plaster will be put on your skin at the biopsy spot. You will have to lie on the bed or trolley for at least 6 hours. During that time, the nurse will take your blood pressure and pulse. This will be every 15 minutes for the first 2 hours, then less frequently. You will be able to eat and drink a little during this time.