Liver Biopsy
Sutter Davis Hospital Gastroenterology

DEFINITION
A liver biopsy is a tiny sample of body tissue -- in this case, liver tissue. The tissue is prepared and stained in a laboratory, so the physician can view it under a microscope. This usually helps the physician make a specific diagnosis and determine the extent and seriousness of the condition. It is vital information for determining treatment.

POSSIBLE COMPLICATIONS
A liver biopsy is a very safe procedure when performed by an experienced doctor. The most common problems include mild pain and a minor decrease in blood pressure. More serious complications, such as bleeding, infection, and injury to nearby organs, are very rare.

BEFORE THE PROCEDURE
Prior to a liver biopsy, a healthcare provider will check blood tests that reflect how well your blood clots. Normal blood clotting is important to prevent bleeding after the biopsy.

You should carry a list of your medications, including over-the-counter medications, herbs, and vitamins. Discuss this list with your physician before the biopsy to see if you need to stop any medications temporarily.

Patients are usually advised not to take medications that can increase the risk of bleeding. These include the following

• Aspirin or aspirin-containing medicines
• Other nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen (eg, Motrin®, Advil®), and naproxen (eg, Aleve®). Many non-prescription medicines contain NSAIDs, so check the labels or ask your pharmacist for help.
• Medicines used to prevent blood clots, such as warfarin (Coumadin®)
• Certain medicines for heart conditions (such as abciximab [Reopro®], dipyridamole [Persantine®], ticlopidine [Ticlid®], and clopidogrel [Plavix®])
• Some herbal therapies (such as fish oil or ginkgo biloba)

It is common to have an ultrasound of the liver and gallbladder area before the biopsy so that your doctor can pinpoint the biopsy site. Ultrasounds are not required in every case; the need for ultrasound will be determined by the doctor who does the biopsy.

You should have nothing to eat or drink for six hours before the procedure. You may be allowed to have a light breakfast only, such as black tea or coffee and toast. Some doctors recommend eating a small amount of fat (such as butter or margarine) with breakfast, which will empty the gallbladder and potentially decrease the risk of gallbladder injury during the biopsy.

DURING THE PROCEDURE

A mild sedative may be given to the patient prior to the procedure. Sometimes, an ultrasound or echo machine is used to identify the best location to make the biopsy. Usually, the physician can make this determination simply by examination. The patient lies quietly on the back or slightly to the left side. That area of the skin where the biopsy will be done is carefully cleaned. Then, a local anesthetic agent is used to numb the skin and tissue below. A specially designed thin needle is inserted through the skin. At this point, the physician will tell the patient how to breathe. The needle is advanced into and out of the liver. This takes only 1 or 2 seconds. A slender core of tissue is removed with the needle, and is then processed through the laboratory. The entire procedure from start to finish lasts only 15 to 20 minutes.

AFTER THE PROCEDURE
Following the liver biopsy, you will be asked to lie on your right side, and a nurse will monitor your blood pressure and pulse periodically. Many people watch television or a video, read, or talk with friends or family.

You will need to arrange to have someone take you home after the biopsy because sedative medications are often used. A friend or family member can also help pass the time during the few hours of observation following the biopsy.

In addition to resting the day of the biopsy, you should plan to take it easy for the next five to seven days. In general, you should not lift more than 15 to 20 pounds for a week, avoid blood thinning medication for several days, and call with any concerning symptoms, including the following:

• Severe pain at the biopsy site or shoulder
• Shortness of breath
• Chest pain
• Bleeding from the biopsy site
• Fever (temperature greater than 100.4ºF or 38ºC)
• Abdominal pain
• Weakness, sweating
• Heart palpitations

Biopsy results - The biopsy report is usually available within a week after the biopsy. Your doctor will make a follow-up appointment to discuss the results of the biopsy and what treatment (if any) is needed.