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by Mary Calvagna, MS

Anatomy and Physiology
The liver is located in the upper right abdomen, just under the diaphragm. It lies almost entirely within the rib cage, which provides some protection to the organ.

The liver is critical for digestion and metabolism. Its many functions include: producing bile, which is necessary for fat absorption, producing proteins from amino acids, packaging fat for storage or transportation in the blood, regulating blood sugar levels, and processing substances such as alcohol and drugs.

Reasons for Procedure
A liver biopsy is a diagnostic procedure in which a small sample of liver tissue is obtained. It is performed to determine the cause of liver disease and the extent of the damage.

A liver biopsy may be ordered to determine the cause of: abnormal liver function tests, jaundice, the yellowish discoloration of the skin and white of the eye that develops when the serum bilirubin is elevated; bilirubin is normally metabolized by the liver, swelling or enlargement of the liver.

These signs and symptoms may be due to a variety of liver conditions, including cirrhosis, hepatitis, and cancer. A liver biopsy can also determine the extent of damage caused by these conditions.

Treatments
The most common way a liver biopsy is obtained is by inserting a needle into the liver from outside the body and withdrawing the tissue sample.

Other less common techniques used for liver biopsy include: laparoscopy, in which a narrow lighted instrument is inserted through a small incision in the abdominal wall, transvenous or transjugular liver biopsy, in which a small tube is inserted into the internal jugular vein in the neck and guided to the liver through the hepatic vein, surgical liver biopsy, which is usually done when a patient undergoes an open abdominal operation.

A liver biopsy is only performed if the necessary information cannot be obtained from alternative, less invasive methods, such as: blood tests, ultrasound, which uses high-pitched sound waves to produce images of the liver, CT scan, which uses x-rays and computers to produce images of the liver, MRI scan, which uses magnets to produce highly detailed images of the liver, Radioisotope scans, which use radioactive materials and detectors to assess the function of both the liver and the gallbladder.

Procedure
In the days leading up to your procedure: Your doctor will schedule blood tests to make sure there are no problems with your blood's clotting function. Under the direction of your physician, you will need to discontinue the use of aspirin, other non-steroidal anti-inflammatory drugs, such as ibuprofen, and anti-coagulant medications prior to the procedure and for several days afterward. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor.

Also during the days leading up to your procedure: Arrange for a ride to and from the hospital. Your doctor may ask you not to eat or drink anything for eight hours before the biopsy, although some specialists recommend a light breakfast to help empty the gallbladder and reduce its risk of being hit by the needle during the procedure. Before the procedure, you will be asked to empty your bladder to be as comfortable as possible. An IV line will be started and you may be given a sedative to help you relax. A liver biopsy is done with local anesthesia, so you will be awake during the procedure.

You will be asked to lie on your back, with your right arm above your head. You will need to lie as still as possible during the procedure. The lung and gallbladder are close to the liver, and moving could cause damage to these organs.

Your doctor will determine the location of your liver by ultrasound or by tapping and feeling. After cleaning the area over the biopsy site with an antiseptic, your doctor will inject a local anesthetic to numb the skin and surface of the liver. Once the skin is numb, your doctor will make a small nick with a surgical blade. This is where the needle will be introduced.

Your doctor will carefully advance the biopsy needle to the surface of the liver. Your doctor will then ask you to hold your breath while he or she advances the needle into the liver and obtains the tissue sample. As soon as the biopsy is obtained, you will be able to breath normally.

You may feel a momentary sensation in your right shoulder during or just after the biopsy. Some patients have pain that requires additional medication, which is provided by your doctor if needed. Afterwards, pressure will be applied at the site of the biopsy to stop any bleeding and a bandage will be placed on the incision. You will need to lie on your right side for a minimum of one hour following the biopsy.

Risks and Benefits
Possible complications of a liver biopsy include: pain that is often felt in the right shoulder, bleeding from the site of needle entry into the liver, puncture of the gallbladder or bile ducts, which may result in bile leakage into the abdomen, puncture of the lung, which may result in a pneumothorax, damage to other nearby structures, such as the right kidney or colon, infection, adverse reactions to the local anesthesia or sedation, if given.

Benefits of liver biopsy include: accurate diagnosis of liver condition, reliable assessment of liver disease severity to help guide treatment decisions.

In a liver biopsy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.

After the Procedure
After the procedure, your blood pressure and heart rate will be closely monitored. After lying on your right side for an hour or two, you will be asked to lie on your back for a minimum of three additional hours. Liver biopsies are considered outpatient procedures. If there are no complications, you will be discharged 4-8 hours after the procedure.

Once you get home: Avoid heavy lifting and strenuous exercise for the next 2-3 days following the biopsy. Your physician may recommend a longer period of rest. You can resume eating a normal diet. Refrain from taking aspirin, other non-steroidal anti-inflammatory drugs, and anticoagulants until your doctor says it is safe to resume. Your doctor may recommend acetaminophen for pain. Be sure to contact your doctor promptly if you experience: fever or chills, severe pain in the abdomen, chest, or shoulder, difficulty breathing, and/or bleeding or discharge from the puncture site.

Sources:

  • Flora KD. Diagnostic liver biopsy. eMedicine website. Available at: http://www.emedicine.com/med/topic2969.htm. Accessed August 6, 2004.
  • Liver biopsy. American Liver Foundation website. Available at: http://liverfoundation.org/db/articles/1019. Accessed August 6, 2004.
  • Liver biopsy. National Digestive Diseases Information Clearinghouse. National Institutes of Health website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/liverbiopsy. Accessed August 6, 2004.
  • Liver biopsy. Veterans Affairs National Hepatitis C website. Available at: http://hepatitis.va.gov/vahep?page=tp03-01-02-01. Accessed August 6, 2004.
  • Liver biopsy factsheet. American Liver Foundation website. Available at: http://liverfoundation.org/db/articles/1081. Accessed August 6, 2004.


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