liver biopsy

Indications

• abnormal liver function tests (without diagnosis)
  • cholestasis
  • steatosis
  • hepatitis
  • vanishing bile duct syndrome
  • hepatic cirrhosis
  • primary biliary cirrhosis
  • primary sclerosing cholangitis
• hepatocellular carcinoma
• hemochromatosis
• Wilson's disease
• methotrexate therapy
• fever of unknown origin
• porphyria cutanea tarda
• non-Hodgkin's lymphoma
• Hodgkin's disease
• hepatomegaly
• liver mass (without diagnosis)

Procedure

• preparation:
  • complete blood count
  • coagulation tests
  • obtain history of anticoagulant (warfarin) or antiplatelet therapy
  • stop taking aspirin, NSAIDs, anticoagulants one week prior to biopsy
  • NPO 8 hours prior to biopsy
• procedure
  • liver biopsy is considered minor surgery (in hospital procedure)
  • sedation
  • patient supine with right hand above head
    • patient must lie still
  • mark outline of your liver & inject local anesthetic
  • make a small incision, then insert the biopsy needle & retrieve sample of liver tissue
    • patient shoud hold breath for 5 to 10 seconds while needle inserted into liver
    • patient may feel pressure and dull pain
  • ultrasound guidance may be useful
• recovery
  • patient on right side, pressed against a towel, for 1-2 hours
  • monitor vital signs & level of pain
  • must remain in hospital or go directly home & remain in bed (except to use the bathroom) for 8 to 12 hours
  • avoid exertion for 1 week
  • irritation of the diaphragm muscle (the pain usually radiates to the shoulder) may occur, but resolve within a few hours or days
  • AVOID aspirin, NSAIDs, anticoagulants for 1 week after surgery

* percutaneous liver biopsy

Entire procedure takes about 20 minutes.

Interpretation

• inter-pathologist agreement is better when sample size is adequate
• community pathologists tend to understage fibrosis in biopsies for hepatitis C (relative to hepatopathologists)

Complications

rare

• nicking the lung or gallbladder
• infection
• bleeding
• pain

Notes

• two other methods of liver biopsy are also available
• laparoscopic biopsy
  • indications:
    • tissue samples from specific parts of the liver
• transvenous biopsy
  • catheter inserted into external jugular vein
  • indications
    • coagulation disorder
    • ascites

More general terms

• tissue biopsy

Additional terms

• liver
• liver disease

Patient information

liver biopsy patient information