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A liver inside a body is next to a syringe, and to the right is a microscope view of a biopsy sample.

Liver Biopsy for Hepatitis C

When diagnosed with hepatitis C, there are many tests to help determine genotype (virus strain), viral load count, and additional tests to know how the liver is functioning. Your physician may also order a liver biopsy to see the condition of your liver. For patients, a liver biopsy can help equip you with knowledge and dispel fear, while also helping you and your doctor to make the best possible choices for your liver and overall health.

What is a liver biopsy?

Liver biopsies are an important diagnostic tool to examine the liver structure and determine the stage of liver disease.

Why is a liver biopsy performed?

A liver biopsy provides extensive information about your liver’s condition. A liver biopsy can help to…

  • Determine the liver structure
  • Diagnose the stage of liver disease
  • Determine if fibrosis or cirrhosis has occurred, and what stage
  • Detect infections and cancer
  • Provide possible causes of liver swelling or abnormal liver enzymes
  • Make treatment decisions

How is a liver biopsy performed?

There are several ways a liver biopsy can be performed.

Percutaneous biopsy or needle biopsy

Commonly referred to as standard needle biopsy, where a needle is inserted near the bottom of your right rib cage to retrieve a small sample of the liver. Light sedation is administered for discomfort, but the patient needs to be conscious so that they can take deep breaths and hold it when necessary while the needle quickly takes the liver sample. This is very quick and over before you know it.

Transjugular biopsy

A small incision is made in the jugular vein. Then, a tube is threaded down to the hepatic vein and a biopsy needle retrieves a small liver sample. This procedure includes the use of x-rays and contrast dye.

A laparoscopic biopsy

A laparoscopic biopsy is performed with general anesthetic. A small incision is made in the abdomen to take samples of the liver.

Fibroscan

Fibroscan is a new method, approved in 2013 in the US. The Fibroscan is a non-invasive procedure (no surgery or needles required). Fibroscans are done with ultrasound, known as transient elastography. A Fibrosan is a procedure done with sound waves that gives an accurate picture of the entire structural condition of the entire liver rather than a local area.

What are the most common ways liver biopsies are done?

The most common procedures for liver biopsies are standard needle (percutaneous) and Fibroscans. Your physician will help determine which procedure is best for you.

How can I prepare for a liver biopsy?

Liver biopsies are done either through an outpatient or hospital facility. If you are having a liver biopsy by methods other than a Fibroscan, you will first have a blood test to make sure your blood clots properly.

Typically, you cannot eat or drink 8 hours prior to having the liver biopsy. Your doctor will need to know all prescription and over the counter medications, vitamins, and herbal supplements you take prior to the procedure. You will be advised which medications, vitamins, and supplements to stop prior to your liver biopsy (due to the risk of bleeding). Depending on the type of liver biopsy, you will be given an IV and may receive a sedative or anesthetics. Usually, if a Fibroscan is done, no preparation is necessary.

What is recovery like?

Depending on your procedure, you may be monitored for several hours in recovery before being dismissed. If you had a Fibroscan, often, no recovery is necessary. A liver biopsy is a great, proactive tool to help you know the condition of your liver and how to take care of your liver.

Have you had a liver biopsy or know the condition of your liver?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The HepatitisC.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Connie Welch moderator author
    3 months ago

    Hi Tash,
    I’m so sorry you’ve had this experience. This is not something that normally occurs. I’ve had two liver biopsies myself and never had that experience. I am glad that you’ve been proactive and relentless in doing everything to move forward with treatment. With Fibroscan’s becoming more available throughout the country, hopefully more people will have access to them.

    Thanks for sharing. Keep us posted on how you’re doing. Best wishes for a great recovery and good health. Connie Welch for Hepatitis C.net

  • Tash
    3 months ago

    I had a liver biopsy & it was the most painful thing ever. When AbbVie agreed to take care of me, we did a 3-way call with my insurance & AbbVie specifically told my insurance I do NOT need a liver biopsy & it would be wrong to force me to do so. Well, my insurance didn’t give a crap what the company who was agreeing to pay for EVERYTHING & take care of me since my insurance clearly had no intentions of doing so & forced me to get a liver biopsy anyways threatening to refuse to give me my denial papers that AbbVie needed unless I agreed to.

    During the biopsy prepping I warned the doctor that I’m prescribed to a benzodiazepine so midazolam would have a hard time sedating me & of course nobody listened except the nurse who was giving me the sedatives finally realized & told me “you really are extremely hard to sedate” (no crap, I tried telling them). I give the nurse props though who proved he was at least listening to me & caught on from my conversations with my mom while waiting for the biopsy that I had a huge fascination with medication because I want to work in the pharmaceutical industry someday so since sedation was out of the question, he decided to try another tactic that I thought was clever yet still almost mean though I didn’t specifically blame the nurse for he had actually listened to me. When the doctor was about to shove the needle into my liver, the nurse pulled out all kinds of tubes of medicine from fentanyl to midazolam etc & started letting me look at them & read them.. until all a sudden I felt a severe pain in my ribcage & I turned to the nurse in shock & said “you tricked me” which he had an apologetic look on his face & said he was sorry but since they couldn’t sedate me he thought that maybe letting me see medicines because he knew I had an interest in pharmaceutical would distract me from the biopsy. I wasn’t angry at him though I was angry at the doctor for not listening & also my insurance definitely not listening. I had pain radiating from my shoulder to my feet nonstop afterwards & the doctor refused to give me anything for pain & instead after 4hrs since the biopsy, sent me home.. with nothing. I couldn’t sleep, couldn’t sit, couldn’t lay down, couldn’t do anything for 3 or more days due to the insane pain. AbbVie wasn’t happy finding out my insurance forced me to get a biopsy anyways, I had only had hep c for less than a year, they said there was no reason to be forced to have one. Whatever, I signed the rest of the paperwork for AbbVie to work with my doctor during the 4hr wait & thought everything was good to go now.

    Until it wasn’t. I got a frantic call from my doctor (my actual specialist, not the biopsy one) saying my insurance was STILL threatening not to give me my denial papers for AbbVie unless I took a bunch of these tests I had already taken but insurance decided I needed to take them again & if I didn’t have them done in 24hrs I wasn’t getting my denial papers. I was FURIOUS. My insurance KNEW I didn’t need a biopsy & KNEW I had already taken these other tests that take on average a few days (sometimes longer) to get the results back.. & we had 24hrs. I live about an hour away from the hospital, but I drove down there immediately to get the tests done & some lab workers volunteered to stay overnight at work to get the results in 24hrs for me. I won though, my insurance could no longer pull any more excuses & demands out because I’ve done everything they could’ve possibly asked & I made sure the denial letter would be sent straight to AbbVie. A week later, I was officially approved for Viekira Pak at no cost to me or my insurance.

    I found out I scored the highest in inflammation as I could in that biopsy but I never started fibrosis or cirrhosis stages. I was mostly furious for the way the entire biopsy went & the fact my insurance deliberately knew I did NOT need it yet forced me to anyways then I wasn’t even sedated but tricked. Looking back, sure it was worth it to be cured today but knowing there’s such thing as a fibroscan or other less painful methods doesn’t make me think any higher of my insurance to say the least.

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