A liver biopsy is a procedure by which a thin core of liver tissue is obtained for analysis under a microscope.
Procedure
- Most liver biopsies are done on an outpatient basis i.e. the patient stays in the hospital for half a day.
- The doctor orders tests to check bleeding and clotting times.
- Patient’s blood group is known and blood available if needed.
- All recent medications are reviewed.
- Aspirin and aspirin like medications should have been stopped.
- Under full aseptic precautions the right side of the chest is cleaned and numbed using local anesthesia.
- Breathing techniques are practiced with the patient.
- Using a long fine needle a core of liver tissue is obtained.
- The actual process takes only 1–2 seconds. This process is repeated and another specimen obtained.
- A dressing is applied and the patient lies on his/her right side for about 2 hours and on the back for another 2 hours.
- After about 4–6 hours a blood sample is drawn. If this sample is similar to the one drawn before the biopsy, no bleeding has occurred and the patient is discharged.
- Sometimes a liver biopsy is done by a Radiologist using an ultrasound or CT scan to guide the needle (US or CT guided liver biopsy).
- In patients with a bleeding disorder it can be done by a catheter inserted into a neck vein and advanced into the liver (transjugular liver biopsy).
- The day after a liver biopsy the patient can resume his normal lifestyle.
Liver Biopsy- Chronic viral hepatitis like Hepatitis B and Hepatitis C.
- Unexplained liver enlargement and liver tests.
- Alcohol induced liver disease.
- Drug induced liver damage.
- Tumors and cancers.
- Systemic diseases and infections affecting the liver.
- After liver transplantation for rejection and other complications.
- Complications of Liver Biopsy
Hemorrhage from Needle Biopsy
- Hemorrhage from the liver at the puncture site is frequent and serious complication.
- Bleeding usually is minimal and at short duration.
Bleeding in the liver from a needle biopsy, may, instead of reaching the peritoneal cavity, enter the biliary tract and escape into the gastrointestinal tract. This is known as hemobilia. It is a rare cause of G. I. bleeding. Early treatment is important since it has a significant mortality if not recognized and corrected.
Hypotension
Ordinarily a sharp drop in B.P. after a needle biopsy of the liver would suggest blood loss. There is often a slow pulse and sharp abdominal pain. It usually lasts an hour or so with recovery.
Bile Peritonitis
Instead of blood, there may be bile leakage from the liver after a needle liver biopsy. Bile escaping into the peritoneal cavity may produce bile peritonitis, with severe abdominal pain, fever and a “Shock–like” state; a situation requiring prompt therapy.
Bleeding
This is an uncommon but serious complication. It is usually controlled by observation and blood transfusion, but may require surgery to stop it.
- Injury to the Gallbladder.
- Bleeding into the bile ducts.
- Injury to the kidney and colon.
- A connection between a vein and an artery called a fistula.
- Irritation of the covering of the lung or liver.