Liver Biopsy
By gi health
Your liver lets you live.
Your liver, located under your right rib cage, normally weighs about three pounds and is the
body's second largest organ. (Your skin is the largest.) The liver is a complex organ that
functions like a "chemical factory" processing many important body substances such as bile,
digestive enzymes, clotting factors, cholesterol, and proteins. It is essential in the
metabolism of fats, carbohydrates, proteins, and the various vitamins and minerals. It helps
control the level of blood sugar and fats. It cleanses the blood and detoxifies drugs and
potentially harmful chemicals such as alcohol. The liver is a storehouse for blood, vitamins
and minerals, and glycogen - the stored form of sugar - the body's major fuel. The liver has
an amazing ability to regenerate and replenish itself, but when disease strikes, this amazing
factory can shut down and serious health problems occur.
There are many kinds of liver disease such as hepatitis. Hepatitis means inflammation of the
liver - usually producing swelling and tenderness and sometimes permanent damage to the
liver. Hepatitis can be caused by alcohol, chemicals and drugs. Alcohol related hepatitis can
lead to permanent liver injury or cirrhosis and eventual liver failure. Acute viral hepatitis is a
common condition in the United States. About 70,000 cases are reported to the U.S. Center
for Disease Control each year, but this represents only a fraction of cases occurring in this
country. Most hepatitis is spread through contact with other infected individuals and
transmitted through feces, blood, and other body fluids. Many individuals with hepatitis are
unaware of how they may have been exposed to the virus. Some individuals develop liver
damage from drug reactions or hereditary conditions such as hemochromatosis, an overload
of iron in the body or Wilson's disease, an overload of copper.
What is a liver biopsy?
A liver biopsy is a procedure performed to obtain a small piece of tissue from the liver. The
specimen can then be examined under a microscope to determine if any liver disease is
present. This test is usually done through a small 1/8th inch incision using a special biopsy
needle and is considered minor surgery. A liver biopsy is performed as an outpatient
procedure and rarely requires an overnight hospital stay.
Reasons for a liver biopsy?
When most of us hear the word biopsy, we immediately think of cancer. Most liver biopsies,
however, are done on patients in whom cancer is not really suspected. Rather, this test is
usually done in cases of suspected liver disease such as chronic hepatitis to determine what,
if any, liver damage may be present. A liver biopsy is also often performed to determine if
excessive iron is present in the liver - a condition called hemochromatosis. Of course, a
biopsy can also be done to search for cancer. What alternative tests could be done? There
are many ways to test the liver including blood tests, sonograms, and x-rays. However, the
most accurate way to assess damage to liver cells is to perform a biopsy and directly
examine the liver cells under a microscope.
What are the risks?
All surgical procedures involve some risk. Fortunately, the risk of liver biopsy is generally
small. Possible complications include pain, internal bleeding, infection, and puncture of an
internal organ such as a lung or the gallbladder. Fortunately, these complications are
uncommon. To minimize these risks, the biopsy is done by a trained physician using sterile
technique after first checking that tests of blood clotting are acceptable.
How do I prepare for a liver biopsy?
There is very little preparation for a liver biopsy. First, blood tests must be done to be sure
the blood clotting function is acceptable for a safe biopsy. If you are on prescription drugs
that affect clotting such as Coumadin, Plavix, Ticlid, Persantine, or Aggrenox, tell your
doctor before your biopsy is scheduled. Also, since aspirin reduces clotting function, it is
best that you avoid aspirin products and NSAIDS, such as Ibuprofen and Indomethacin, for
at least a week before your biopsy. Tylenol does not alter blood clotting and is safe. You will
need to fast after midnight. If you are a diabetic, do not take your morning insulin or any
pills prescribed for your diabetes. Your biopsy will be scheduled in the early morning.
An appointment will be scheduled at the local hospital outpatient surgery department. You
must arrive about an hour before the biopsy and come fasting. You may take all your
normal medications except insulin, oral diabetic agents, and blood thinners as described
above. You will not be able to drive home so a driver must either accompany you or be
available at the time of discharge, about 6 hours later. You must plan to go directly home
after the biopsy. You will not be able to work or drive a car that day. You should avoid any
heavy exertion and vigorous exercise for about a week.
What is involved?
About the size of a football, your liver is located under your right rib cage. A liver biopsy is
usually performed right in your bed in the outpatient surgery department. After answering
all of your questions, you will be asked to sign an informed consent form that gives your
doctor permission to perform the biopsy. Sometimes, an ultrasound or CT scan is used to
determine the best spot for liver biopsy. Your right side will be cleansed with an iodine
antiseptic solution. A numbing anesthetic medication will then be injected in the location
where the biopsy will be performed. If you are allergic to Novocaine or Lidocaine, be sure to
tell your doctor before the biopsy begins. Once the area is numb, a small incision will be
made in the skin. Using a special needle, your doctor will obtain one or more small cores of
tissue from the liver. During each pass of the needle, you will be asked to hold your breath
for about 10 seconds. Most patients report a brief feeling of discomfort during the biopsy but not severe pain.
What can I expect after my biopsy?
After a liver biopsy, you will be asked to remain in the recovery room for several hours to
be observed for any post-biopsy complications. Serious complications are rare, but most
patients will have some soreness at the biopsy site when the local anesthetic wears off.
Irritation of the diaphragm muscle which lies over the liver can also cause some patients
mild discomfort in their right shoulder. This soreness usually subsides in a few hours or
days. If you notice any severe abdominal, chest, or shoulder pain in the week after your
liver biopsy, contact your doctor. Minor soreness can usually be treated with Tylenol. To
lessen the risk of bleeding, do not take any aspirin or ibuprofen products for one week after
a liver biopsy. If you take prescription "blood thinners," ask your doctor for instructions.
What if a complication does occur?
Should a serious complication occur, you will be admitted to the hospital. This would usually
mean a few days of further observation and medical treatment, but could mean an
operation to treat internal complications. Again, such complication are quite rare.
How do I get the results of my biopsy?
After a liver biopsy, the specimen is sent to the hospital pathology laboratory where the
tissue must undergo special processing and examination. The slides are then examined by a
doctor trained in reading biopsies - a pathologist. A report will be sent to the doctor who
performed the biopsy. This will take about a week - longer if special stains are needed. Your
doctor will then contact you with the results of the biopsy and plans for treatment if
necessary.