Liver Biopsy

What you can expect during your liver biopsy will depend on the type of procedure you’ll undergo. A percutaneous liver biopsy is the most common type of liver biopsy, but it isn’t an option for everyone. Your doctor may recommend a different form of liver biopsy if you:

• Could have trouble holding still during the procedure
• Have a history of or likelihood of bleeding problems or blood-clotting disorders
• Might have a tumor involving blood vessels in your liver
• Have an abnormal amount of fluid in your abdomen (ascites)
• Are very obese
• Have a liver infection

During the procedure

A liver biopsy is done at a hospital or outpatient center. You’ll likely arrive early in the morning.

Just before your biopsy you will:

• Have an IV line placed, usually into a vein in your arm, so that you can be given medications if you need them
• Possibly be given a sedative to help you relax during the procedure
• Use the toilet if needed because you’ll need to remain in bed for a few hours after the procedure

The steps involved in liver biopsy vary according to the type:

• Percutaneous biopsy. To begin your procedure, your doctor will locate your liver by tapping on your abdomen or using ultrasound images. In certain situations, ultrasound might be used during the biopsy to guide the needle into your liver. You’ll lie on your back and position your right hand above your head on the table.
  Your doctor will apply a numbing medication to the area where the needle will be inserted. The doctor then makes a small incision near the bottom of your rib cage on your right side and inserts the biopsy needle. The biopsy itself takes just a few seconds. As the needle passes quickly in and out of your liver, you’ll be asked to hold your breath.
• Transjugular biopsy. You’ll lie on your back on an X-ray table. Your doctor applies a numbing medication to one side of your neck, makes a small incision and inserts a flexible plastic tube into your jugular vein. The tube is threaded down the jugular vein and into the large vein in your liver (hepatic vein).
  Your doctor then injects a contrast dye into the tube and makes a series of X-ray images. The dye shows up on the images, allowing the doctor to see the hepatic vein. A biopsy needle is then threaded through the tube, and one or more liver samples are removed. The catheter is carefully removed, and the incision on your neck is covered with a bandage.
• Laparoscopic biopsy. During a laparoscopic biopsy, you’ll likely receive general anesthetics. You’ll be positioned on your back on an operating table and your doctor will make one or more small incisions in your abdomen.
  Special tools are inserted through the incisions, including a tiny video camera that projects images on a monitor in the operating room. The doctor uses the video images to guide the tools to the liver to remove tissue samples. The tools are removed and the incisions are closed with stitches.

After the procedure

After the biopsy, you can expect to:

• Be taken to a recovery room, where a nurse will monitor your blood pressure, pulse and breathing
• Rest quietly for two to four hours, or longer if you had a transjugular procedure
• Feel some soreness where the needle was inserted, which may last as long as a week
• Have someone drive you home, since you won’t be able to drive until the sedative wears off
• Avoid lifting more than 10 to 15 pounds for one week
• Be able to get back to your usual activities gradually over a period of a week