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Liver biopsy
In a liver biopsy, the physician examines a small piece
of tissue from your liver for signs of damage or disease. A special
needle is used to remove the tissue from the liver. The physician
decides to do a liver biopsy after tests suggest that the liver does
not work properly. For example, a blood test might show that your
blood contains higher than normal levels of liver enzymes or too much
iron or copper. An x ray could suggest that the liver is swollen.
Looking at liver tissue itself is the best way to determine whether
the liver is healthy or what is causing it to be damaged.
Preparation
Before scheduling your biopsy, the physician will take blood samples
to make sure your blood clots properly. Be sure to mention any
medications you take, especially those that affect blood clotting,
like blood thinners. One week before the procedure, you will have to
stop taking aspirin, ibuprofen, and anticoagulants.
You must not eat or drink anything for 8 hours before the biopsy, and
you should plan to arrive at the hospital about an hour before the
scheduled time of the procedure. Your physician will tell you whether
to take your regular medications during the fasting period and may
give you other special instructions.
Procedure
Liver biopsy is considered minor surgery and so it is done at the
hospital. For the biopsy, you will lie on a hospital bed on your back
with your right hand above your head. After marking the outline of
your liver and injecting a local anesthetic to numb the area, the
physician will make a small incision in your right side near your rib
cage, then insert the biopsy needle and retrieve a sample of liver
tissue. In some cases, the physician may use an ultrasound image of
the liver to help guide the needle to a specific spot.
You will need to hold very still so that the physician does not nick
the lung or gallbladder, which are close to the liver. The physician
will ask you to hold your breath for 5 to 10 seconds while he or she
puts the needle in your liver. You may feel pressure and a dull pain.
The entire procedure takes about 20 minutes.
Two other methods of liver biopsy are also available. For a
laparoscopic biopsy, the physician inserts a special tube called a
laparoscope through an incision in the abdomen. The laparoscope sends
images of the liver to a monitor. The physician watches the monitor
and uses instruments in the laparoscope to remove tissue samples from
one or more parts of the liver. Physicians use this type of biopsy
when they need tissue samples from specific parts of the liver.
Transvenous biopsy involves inserting a tube called a catheter into a
vein in the neck and guiding it to the liver. The physician puts a
biopsy needle into the catheter and then into the liver. Physicians
use this procedure when patients have blood-clotting problems or fluid
in the abdomen.
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Recovery
After the biopsy, the physician will put a bandage over the incision
and have you lie on your right side, pressed against a towel, for 1 to
2 hours. The nurse will monitor your vital signs and level of pain.
You will need to arrange for someone to take you home from the
hospital since you will not be allowed to drive after having the
sedative. You must go directly home and remain in bed (except to use
the bathroom) for 8 to 12 hours, depending on your physician's
instructions. Also, avoid exertion for the next week so that the
incision and liver can heal. You can expect a little soreness at the
incision site and possibly some pain in your right shoulder. This pain
is caused by irritation of the diaphragm muscle (the pain usually
radiates to the shoulder) and should disappear within a few hours or
days. Your physician may recommend that you take Tylenol for pain, but
you must not take aspirin or ibuprofen for the first week after
surgery. These medicines decrease blood clotting, which is crucial for
healing.
Like any surgery, liver biopsy does have some risks, such as puncture
of the lung or gallbladder, infection, bleeding, and pain, but these
complications are rare.
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