What is a Liver Biopsy?

A liver biopsy is a diagnostic procedure employed to assess liver conditions. During the procedure, small tissue samples are extracted from the liver and examined under a microscope to detect any indications of damage or disease. This biopsy enables the identification of cancer cells or other abnormal cells within the liver while also providing insights into the liver's overall functionality and health status.

What are the different types of Liver Biopsy?

There are three types of liver biopsies:

1. Percutaneous liver biopsy is the most common method for administering local anaesthesia. A small needle is inserted into the liver to obtain a tissue sample.

2. Laparoscopic liver biopsy: General anaesthesia is given in this procedure. A thin, lighted tube known as a laparoscope is inserted through a small incision in the skin. The laparoscope is equipped with a tiny video camera that allows the healthcare provider to visualize the inside of the abdomen on a computer screen. A needle is then passed through another tube to collect the tissue sample.

3. Transvenous liver biopsy: This method may be chosen for individuals with blood-clotting issues or abdominal fluid accumulation. After administering local anaesthesia, an incision is made into a vein in the neck. A hollow tube is inserted through the vein to reach the liver. Contrast dye is injected into the tube, and X-rays are taken to enhance the visibility of the vein. A needle is then passed through the tube to obtain tissue samples from the liver.

Why is it done?

There are several reasons for undergoing a liver biopsy:

1. Diagnosis: Liver biopsy is considered the gold standard for diagnosing various liver diseases and lesions that other tests may suggest but cannot conclusively confirm. It provides definitive confirmation or exclusion of these conditions, sometimes being the only method to do so.

2. Staging: A liver biopsy may also be performed to assess the progression of chronic liver disease. By determining the extent of fibrosis (scarring) in the liver and assigning a score (F0- F4), the biopsy helps predict prognosis, guide treatment decisions, and evaluate treatment efficacy.

What conditions can a liver biopsy diagnose?

A liver biopsy is instrumental in diagnosing various liver conditions, including:

• Fatty liver disease
• Chronic hepatitis
• Cirrhosis of the liver
• Liver cancer

Moreover, it enables the identification of specific causes or types of liver disease, such as:

• Alcohol-related liver disease
• Autoimmune hepatitis
• Hodgkin lymphoma
• Metastatic cancer
• Non-alcohol-related fatty liver disease
• Non-Hodgkin lymphoma
• Toxic hepatitis
• Tuberculosis
• Viral hepatitis (B or C)

What happens during a liver biopsy?

Liver biopsy procedures are typically conducted at a hospital or an outpatient centre, with patients arriving early in the morning. Just before the biopsy, the following steps are undertaken:

1. IV Placement: An intravenous (IV) line is inserted, typically into a vein in the arm, to facilitate medication administration if necessary.

2. Sedative Administration: Patients may be given a sedative to promote relaxation during the procedure.

3. Preparation for Bed Rest: Patients are encouraged to use the restroom if needed, as they must remain in bed for a few hours after the procedure.

The steps involved in the liver biopsy vary depending on the type:

1. Percutaneous Biopsy:

• The provider locates the liver either by tapping on the abdomen or using ultrasound imaging.
• Numbing medication is applied to the biopsy site, usually near the bottom of the rib cage on the right side.
• A small incision is made, and a biopsy needle is inserted into the liver.
• The biopsy itself is a quick process, with the needle passing in and out of the liver while the patient holds their breath.

2. Trans jugular Biopsy:

• Patients lie on their backs on an X-ray table.
• Numbing medicine is applied to one side of the neck, followed by a small incision.
• A flexible plastic tube is inserted into the jugular vein and threaded down to the hepatic vein in the liver.
• A contrast dye is injected to visualize the hepatic vein on X-ray images.
• A biopsy needle is passed through the tube to obtain liver samples.

3. Laparoscopic Biopsy:

• Patients receive general anaesthesia.
• They lie on their back on an operating table, and small incisions are made in the abdomen.
• Special tools, including a tiny video camera, are inserted through the incisions to guide the removal of tissue samples from the liver.
• After sample collection, the tools are removed, and the incisions are closed with stitches.

After the Procedure

Following the biopsy procedure, you can anticipate the following:

1. Recovery Room Monitoring: You will be taken to a recovery room where a nurse will monitor your vital signs, such as blood pressure, pulse, and breathing.

2. Rest Period: Plan to rest quietly for 2 to 4 hours or longer if you underwent a trans jugular procedure.

3. Soreness: You may experience some soreness at the needle's insertion site, which could last up to a week.

4. Transportation: Since the sedative effects may still be present, it's essential to have someone drive you home, as you won't be able to operate a vehicle until the sedative wears off.

5. Activity Restrictions: Avoid lifting objects heavier than 10 to 15 pounds for at least one week to prevent strain or injury.

6. Gradual Return to Activities: You can gradually resume your usual activities over a week, allowing your body time to recover fully.

Complications of liver biopsy

Common complications may include:

1. Pain: Temporary discomfort may occur after the procedure, typically in the region of the liver (upper abdominal pain) or radiating to the right shoulder. This pain is often mild and can be easily managed with medications. However, severe or prolonged pain may indicate other underlying complications.

2. Low Blood Pressure: Some individuals may experience a temporary decrease in blood pressure following the procedure, which may cause slight light-headedness. This is usually transient and not considered a serious concern. However, if there is a significant drop in blood pressure accompanied by weakness or dizziness, it could be indicative of internal bleeding.

Rare but serious complications include:

1. Internal Bleeding: Although rare, internal bleeding can occur as a complication of the biopsy procedure.

2. Infection at the biopsy site or within the liver is a rare but potentially serious complication.

3. Bile Leak: In some cases, a bile leak may occur, leading to symptoms such as abdominal pain and jaundice.

4. Pneumothorax: This is a rare complication where air leaks into the space between the lungs and chest wall, potentially causing chest pain and difficulty breathing.

Speak to our team about Liver biopsy

"Speak to our experts about liver biopsy and ensure thorough evaluation and personalized care for your liver health. Our experienced team of healthcare professionals is dedicated to providing comprehensive services tailored to your needs. Whether you require a liver biopsy for diagnostic purposes or to monitor the progression of liver conditions, our specialists are here to guide you through every step. With advanced techniques and compassionate care, we strive to ensure the safety and well-being of our patients. Schedule a consultation with our experts today to discuss your concerns and determine the best course of action for your liver health."