Liver Biopsy

There are a number of different types of liver biopsy procedures, originating from the late 1800s, which are used for the diagnosis of medical conditions and diseases affecting the liver and organs connected to the liver. The liver plays a vital function in the human body for fighting infection, digesting foods, processing and storing vitamins, minerals and nutrients, in addition to removing chemicals from the blood, which in excess can be harmful to the body.

What is a liver biopsy?

A liver Biopsy is a medical procedure used to remove samples of tissue cells from the liver for microscopic evaluation, to determine diagnosis and monitor the health of the liver for treatment.

Are there different types of liver biopsy?

There are three main types of liver biopsy based on where the cell samples are removed from:

Percutaneous: a needle is inserted through the skin into the liver in patients where the risk of bleeding, infection and cancer is low.
Travenous: a needle is placed in the blood vessels via the neck into the liver in patients where bleeding is a risk.
Abdominal or Laparoscopic: a medical instrument is used via surgery to reduce the risk of spreading cancer or infection in patients with this condition.

When is a liver biopsy necessary?

A doctor will recommend a liver biopsy if a patient's symptoms indicate disorder of the liver function, if a patient is taking medication that can cause liver deterioration, if the patient is an alcoholic, or if blood tests results are abnormal. A liver biopsy is a means of confirming the cause and severity of liver disease and monitoring treatment that follows.

What medical conditions may require a liver biopsy?

Medical conditions and diseases that may require a liver biopsy include:

Cancer: abnormal cell growth in the liver.
Hepatitis: inflammation of the liver, such as Hepatitis B and C.
Tuberculosis: tubercular lesions develop in the liver.
Cirrhosis: fibrosis scarring of the liver.
Metabolic: autoimmune liver disorders, such as Haemochromatosis (excess iron) and Wilson's disease (excess copper).

How do I prepare for a liver biopsy?

Your medical practitioner will give you personalised information on how to prepare for your liver biopsy, as it very much depends on whether you have specific health conditions or take particular medications. The main criteria of concern in biopsy is bleeding, so you will usually be advised to refrain a week prior from taking any medications that may impact your blood's capacity to clot, such as aspirin, antibiotics, antidepressants and medicines for high blood pressure, asthma and diabetes.

Usually patients are asked not to eat or drink at least eight hours before the biopsy. Patients are typically given information about liver biopsies before the procedure, so that any questions can be answered and they understand what they are consenting to when signing the form.

What procedures are involved in a liver biopsy?

The liver biopsy procedure – where there are no complications due to a patient's existing health condition, such as being prone to bleeding – involves different stages, which include:

Blood test: to determine blood level of clotting.
Sterilisation: once lying flat the skin on the right-hand side of your body, where your liver is located under your ribs and diaphragm above your abdomen, are sterilised with an antiseptic.
Anaesthesia: to numb the skin a local anaesthetic is injected above but near the site of intended biopsy.
Ultrasound / computerised tomography (CT): an ultrasound or CT device may be used to locate the precise site in the liver where the biopsy needle will be injected and where the sample will be taken from.
Biopsy injection: a needle with a hollow for the sample is injected through the skin into the liver and the doctor will tell you when to hold your breath, for about 10 seconds, before the biopsy needle is removed with the sample of liver tissue cells.

Alternate liver biopsy procedures:

Where a patient may have an existing medical condition that affects their blood’s capacity to clot and causes bleeding, alternate liver biopsy procedures are necessary to remove a sample of tissue from the liver with the least risk of bleeding. The catheter liver biopsy method is used as an alternative and involves initial local anaesthesia for numbness, before a thin catheter tube with a needle is injected via the neck or groin vein into the liver veins and a sample of liver tissue is taken, before the catheter and sample are retrieved.

Are there risks or complications with a liver biopsy?

Complications may arise if a patient has a bleeding condition in which the blood does not clot. However, measures are usually put in place to reduce the risk of this happening. In the event of sudden unexpected bleeding, patients are immediately treated and given a blood transfusion if necessary. Medical practitioners usually do preparatory tests and monitor patients after biopsy, in case a complication arises, such as bleeding, internal bile leakage from the liver or infection. Controls are in place to manage the risk of such complications and doctors are qualified to provide appropriate treatment.

Are there guidelines to follow after a liver biopsy?

As a precaution medical practitioners will monitor a liver biopsy patient for several hours after the biopsy, sometimes requiring an overnight hospital stay, to ensure there are no complications, or that treatment can be administered if any occur. Painkillers may be prescribed if discomfort or pain is experienced. General care guidelines once you go home may include:

Avoiding rigorous physical activity so that the liver can heal.
Contacting the doctor if you experience high temperature, irritated red skin where the biopsy was taken and/or pain during the three days following the biopsy.
No driving for at least twelve hours after.

How long does it take to get the liver biopsy results?

A Pathologist who specialises in assessing liver biopsy samples to diagnose disease needs to receive and assess the sample under a microscope before returning the results to your doctor. It therefore takes from one to two weeks to get the results back.