What is a liver biopsy?
A liver biopsy is a test that takes a small piece of your liver and allows your doctor to look at it under a microscope. It may be used to diagnose the type of liver disease you have. More commonly it is used to determine if you have inflammation (swelling) of the liver tissue and the amount of scar tissue (fibrosis) in your liver.
How is a liver biopsy done?
A liver biopsy is done at a hospital and can be done 3 different ways. Sometimes your liver doctor will do it themselves. When this is the case, the doctor will locate the liver, by tapping on your abdomen. Some freezing (similar to the dentist) will be given in the area around the liver. A needle will be quickly passed into the liver and a small piece of liver removed. The test only takes a few minutes, however you will need to remain at the hospital for 2-4 hours to be monitored for bleeding. About half of all patients have a bit of pain which is relieved with mild pain killers, such as Tylenol. Rarely bleeding may occur resulting in an overnight stay at the hospital.
The second method is done in the x-ray department. A doctor specializing in x-ray will find the liver using an ultrasound or CT pictures. Freezing will be given and a needle will be placed into the liver in order to remove a small piece. The recovery time is the same as above. This technique is often used when a specific area or spot on the liver needs to be tested.
The third method of liver biopsy is called transjugular or transvenous liver biopsy. This type of biopsy is often done when blood clotting is a concern or if the person has a lot of fluid in their abdomen (ascites). This is also done by a specially trained x-ray doctor. This type of biopsy is done through a vein in the neck. Freezing is given, and a needle and wire are inserted and threaded into the veins until they reach the liver. Once in the liver a small piece is obtained to send to the lab. With this method, there is usually no pain and bleeding is very rare. This method also allows your doctor to request special measurements of pressures in your blood vessels that go in and out of the liver. This is sometimes useful for diagnosis of other problems that mimic liver disease. You are required to stay at the hospital for 2-4 hours after the biopsy for monitoring.
Who needs a liver biopsy?
Liver biopsies are useful for diagnosing liver diseases which may not be confirmed by blood tests alone. It also allows your doctor to confirm how much inflammation (swelling) or scar tissue (fibrosis) is in your liver. Liver biopsies continue to be used after a liver transplant to differentiate between disease recurrence and rejection. If your doctor only requires information about scar tissue and they have access to a fibroscan, that is the preferred method of fibrosis measurement. Some areas of the country do not have fibroscan and continue to rely on liver biopsy for measurement of fibrosis.
What does my doctor need to know?
You should tell your doctor all of the medicines you are taking. Blood thinners (i.e. Coumadin), anti-inflammatories (ibuprofen, naproxen etc) and aspirin will likely need to be stopped for a period of time before the biopsy.