Patient information: Liver biopsy

LIVER BIOPSY OVERVIEW

The liver is a large organ that is located in the right upper abdomen, beneath the rib cage (figure 1). It performs many functions that are essential to life.

A liver biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. Liver biopsy may be recommended to diagnose a problem or determine the severity of liver disease.

REASONS FOR LIVER BIOPSY

As a general rule, a liver biopsy is recommended only when the results would influence a management decision. Some of the more common indications are in patients with:

• Non-alcoholic fatty liver disease (NAFLD) — NAFLD is a condition in which there is increased amounts of fat in the liver, sometimes in association with inflammation or scarring. NAFLD is the most common reason for liver biopsy. (See "Patient information: Nonalcoholic steatohepatitis (NASH)".)

• Certain liver diseases, such as chronic hepatitis B or C, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, hemochromatosis or Wilson's disease. A biopsy can provide information about the severity of liver injury. (See "Patient information: Hepatitis B" and "Patient information: Hepatitis C" and "Patient information: Hemochromatosis (hereditary iron overload)" and "Patient information: Autoimmune hepatitis".)

• Unexplained liver disease or abnormal liver function tests (blood tests that reflect injury to the liver)
• Monitoring the liver following a liver transplant

A liver biopsy may also be helpful in people with unexplained fevers, those with certain rare metabolic diseases, and other less common disorders.

LIVER BIOPSY PREPARATIONS

Prior to a liver biopsy, a healthcare provider will check blood tests that reflect how well the 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. This can be discussed with your physician before the biopsy to determine if any medications need to be stopped temporarily.

Medications to avoid before liver biopsy — Patients are usually advised not to take medications that can increase the risk of bleeding. These include the following

• Aspirin or aspirin-containing medications
• Other nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen (eg, Motrin®, Advil®), and naproxen (eg, Aleve®). NSAIDs are contained in many over-the-counter preparations.
• Anticoagulant medications such as warfarin (Coumadin®)
• Certain medications for people with heart conditions (such as abciximab [Reopro®], dipyridamole [Persantine®], ticlopidine [Ticlid®], and clopidogrel [Plavix®])
• Some herbal therapies (such as fish oil or ginkgo biloba).

Testing before liver biopsy — It is common to have an ultrasound examination of the liver and gallbladder area before the biopsy so that the physician can locate the biopsy site. Ultrasound examinations are not done for every patient in every institution; the need for ultrasound will be determined by the doctor who does the biopsy.

Eating before liver biopsy — You should have nothing to eat or drink for six hours before the procedure; some patients may be allowed to have a light breakfast only, such as 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.

LIVER BIOPSY PROCEDURE

Most liver biopsies are done in a hospital. Upon arrival for the biopsy (usually in the early morning), the healthcare providers involved in the procedure will review your medical history, including medications and allergies. You may have an intravenous line placed (a needle is inserted into a vein) so that fluid and medications can be administered if needed.

You may be given pain-relieving and sedative medications prior to the procedure to minimize discomfort and anxiety. Because your cooperation is needed during a liver biopsy, you will not be given medication to induce sleep.

The biopsy itself only takes a few seconds as the biopsy needle is passed quickly in and out of the liver. A small bandage will be applied to the biopsy site; stitches are not needed.

LIVER BIOPSY COMPLICATIONS

A liver biopsy is a very safe procedure when performed by experienced physicians. The most common complications include pain, low blood pressure, bleeding, infection, and accidental injury of surrounding organs. However, most of these complications are minor and can be treated. Only 2 to 3 percent of patients require hospitalization after a liver biopsy.

CARE AFTER LIVER BIOPSY

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

You will need to arrange to have someone accompany 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 100.4º F or 38º C)
• Abdominal pain
• Weakness, sweating
• Heart palpitations

Biopsy results — The biopsy report is usually available within a few days to a week after the biopsy. Patients usually have a follow-up appointment to discuss the results of the biopsy and what treatment (if any) is needed.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:
Patient information: Nonalcoholic steatohepatitis (NASH)
Patient information: Hepatitis B
Patient information: Hepatitis C
Patient information: Hemochromatosis (hereditary iron overload)
Patient information: Autoimmune hepatitis

Professional Level Information:
Percutaneous liver biopsy
Transjugular, laparoscopic and fine needle aspiration liver biopsy

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/healthtopics.html)

• National Institute of Diabetes and Digestive and Kidney Diseases

      (www.niddk.nih.gov/)

• The American Liver Foundation

      (www.liverfoundation.org)

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