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With a liver biopsy (BYE-op-see), the physician is able to examine a
small piece of tissue from your liver for signs of damage or disease. This
procedure involves using a special needle to remove tissue from the liver.
The physician decides to do a liver biopsy after tests suggest that the
liver does not work properly. For example, a blood test might show that
your blood contains higher than normal levels of liver enzymes or too much
iron or copper. An x-ray could suggest that the liver is swollen. Looking
at liver tissue itself is the best way to determine whether the liver is
healthy.
This picture shows the liver and nearby organs.
Before scheduling your biopsy, the physician will take blood samples to
make sure your blood clots properly. Be sure to mention any medications
you take, especially those, like blood thinners, that affect blood
clotting. One week before the surgery, you will have to stop taking
aspirin, ibuprofen, and anticoagulants. You will also have a chest x-ray.
You must not eat or drink anything for 8 hours before the biopsy, and
you should plan to arrive at the hospital about an hour before the
scheduled time of the surgery. Your physician will tell you whether to
take your normal medications during the fasting period and may give you
other special instructions.
Liver biopsy is considered minor surgery and is done at the hospital.
The nurse will start an intravenous line to give you medication for the
procedure. For the biopsy, you will lie on a hospital bed on your back or
turned slightly to the left side, with your right hand above your head.
After marking the outline of your liver and injecting a local anesthetic
to numb the area, the physician will make a small incision in your right
side near your rib cage, then insert the biopsy needle and retrieve a
sample of liver tissue. In some cases, the physician may use an ultrasound
image of the liver to help guide the needle to a specific spot.
You will need to hold very still so that the physician does not nick
the lung or gallbladder, which are close to the liver. The physician will
ask you to hold your breath for 5 to 10 seconds while he or she puts the
needle in your liver. You may feel a dull pain. The entire procedure takes
about 20 minutes.
Two other methods of liver biopsy are also available. For a
laparoscopic biopsy, the physician inserts a special tube called a
laparoscope through an incision in the abdomen. The laparoscope sends
images of the liver to a monitor. The physician watches the monitor and
uses instruments in the laparoscope to remove tissue samples from one or
more parts of the liver. Physicians use this type of biopsy when they need
tissue samples from specific parts of the liver.
Transvenous biopsy involves inserting a tube called a catheter
into a vein in the neck and guiding it to the liver. The physician puts a
biopsy needle into the catheter and then into the liver. Physicians use
this procedure when patients have blood-clotting problems or fluid in the
hospital since you will not be allowed to drive after having the sedative.
You must go directly home and remain in bed (except to use the bathroom)
for 8 to 12 hours, depending on your physician's instructions. Also, be
sure not to exert yourself too much for the next week so that the incision
and liver can heal. You can expect a little soreness at the incision site,
and you might have some pain in your right shoulder. This pain is caused
by irritation of the diaphragm muscle (the pain usually radiates to the
shoulder) and should disappear within a few hours or days. Your physician
may recommend that you take Tylenol for pain, but you must not take
aspirin or ibuprofen for the first week after surgery. These medicines
decrease blood clotting, which is crucial for healing.
Like any surgery, liver biopsy does have some risks, such as puncture
of the lung or gallbladder, infection, bleeding, and pain, but these
complications are rare.
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