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What Is a Liver Biopsy?

Helpful in the diagnosis of various liver diseases, a liver biopsy is a medical procedure whereby tiny specimens of liver tissue are taken. They are then sent to a medical laboratory where a thorough examination can be completed.

A liver biopsy is performed to diagnose and monitor diseases that affect the liver and bile ducts. In most cases, a biopsy can provide a very specific diagnosis.

In addition, once a course of treatment for liver disease has begun, biopsies help health care providers to monitor the effectiveness of various therapies, as well as indicate whether or not certain therapy types are causing damage to a patient's liver.

How Is a Liver Biopsy Performed?

Several methods are used to obtain liver samples including laparoscopic liver biopsy, percutaneous image-guided liver biopsy, and open surgical liver biopsy.

Laparoscopic Liver Biopsy¹
A laparoscope is a magnifying telescope that allows an excellent view of the liver's surface. Using trocars (shafts with three-sided points), small incisions are made in the abdomen to enable insertion of the laparoscope, which sends images of the liver to a monitor. Using the monitor to facilitate viewing, the physician uses instruments within the laparoscope to remove tissue samples from one or more parts of the liver. This type of biopsy is used when samples from specific parts of the liver are required.

Percutaneous Liver Biopsy
In a percutaneous (passing through the skin) liver biopsy, patient cooperation is vital. A local anesthetic is first administered to numb the area on the body's right side. The physician then makes a small incision near the rib cage, and inserts a special biopsy needle to retrieve liver tissue samples. In some cases, the physician may use ultrasound imaging or computed axial tomography (CAT) scans of the liver to help guide the needle to a specific spot. This biopsy method is often used when the disease process is localized to discrete spots in the liver.

Open Surgical Liver Biopsy²
Rarely performed today unless as part of another operative procedure, open liver biopsies are done by a surgeon using a biopsy needle, or through surgically excising a small piece of liver tissue.

Liver Biopsies Are Performed to Diagnose,

• Alcoholic liver disease
• Alpha-1-antitrypsin deficiency (a disorder caused by defective production of the glycoprotein alpha-1-antitrypsin)
• Autoimmune disorders of the liver and bile ducts, such as autoimmune hepatitis
• Biliary tract obstruction/jaundice
• Cancers originating in the liver
• Cancers that spread (metastasize) to the liver from other sites
• Chronic hepatitis B or C
• Elevated liver enzymes of unknown cause
• Hepatomegaly (liver enlargement) of undetermined cause
• Metabolic liver disease such as hemochromatosis and Wilson's disease
• Non-alcoholic fatty liver disease (NAFLD)
• Non-cancerous tumors or abnormalities in the liver
• Possible injury due to drug therapies
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Unexplained liver disease or abnormal liver function tests (blood tests that reflect injury to the liver)

Liver Biopsies Are Used to Monitor,

• A variety of uncommon liver disorders
• Chronic viral hepatitis
• HIV/AIDS
• Liver transplantation (to rule out rejection or infection)
• Rare metabolic diseases
• Unexplained fevers

Preparing for a Liver Biopsy

It is vital to compile a list of your current medications, and review them with your health care provider prior to the biopsy. Include all over-the-counter medications, herbs, and vitamins.

You will be instructed to avoid medications that may increase the risk of bleeding, such as,

• Aspirin or aspirin-containing medications
• Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen
• Anti-coagulants such as warfarin
• Certain heart medications such as abciximab, dipyridamole, ticlopidine, and clopidogrel
• Various herbal remedies such as fish oil and ginkgo biloba

Your health care provider will perform blood tests to confirm your blood clotting capacity is normal.

In some cases, an ultrasound is carried out, examining your liver and gallbladder to determine the best biopsy site.

You will be advised not to eat or drink anything for six hours prior to the biopsy.

It is necessary to arrange post-biopsy transportation as sedatives are often administered.

Potential Complications from a Liver Biopsy

Discomfort – lasting for less than twenty-four hours – at the biopsy site, right upper abdomen, or right shoulder is experienced by twenty-five percent of liver biopsy patients. And though complications are rare – experienced in only two to three percent of biopsies – it's important to familiarize yourself with the signs and symptoms of liver biopsy complications.

• Abdominal swelling or bloating
• Chest pain
• Discharge, pain, redness, or swelling around the needle insertion sites or incisions
• Dizziness or fainting
• Fever
• Nausea or vomiting
• Shortness of breath
• Worsening abdominal pain

If you are experiencing any of these symptoms after your biopsy, it is best to consult your health care provider as soon as possible.

For more information on the liver, please review the liver cleansing overview article, or search for related articles by using the search box.

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Notes:
1. Health News Flash.com, "Liver biopsy procedure," http://www.healthnewsflash.com/conditions/liver_biopsy.php#proc (accessed October 22, 2007).
2. eMedicine Health.com, "Liver biopsy overview," http://www.emedicinehealth.com/liver_biopsy/article_em.htm (accessed October 22, 2007).