Liver biopsy

RATE

A liver biopsy is an effective tool for assessing the damage that hepatitis C (HCV) may have done to your liver. The procedure is usually done in an outpatient setting and does not require a stay in the hospital. The most common type of liver biopsy is a percutaneous or “through the skin” biopsy. You may be given medications to make you comfortable. A small sample of liver tissue is obtained which is sent to a laboratory for analysis. 1

Results from liver biopsy can be used to:

    • Determine the stage of liver disease
    • Exclude other causes of abnormal liver testing
    • Guide decisions for HCV antiviral treatment (such as length of treatment)
    • Monitor disease progression and treatment responsee
    • Help identify a co-existing condition, such as fatty liver disease, and determine how much that condition is contributing to liver disease

Preparing for a liver biopsy

There are a few important things you will need to do to prepare for your liver biopsy. These include some routine testing that is done before the procedure. In addition, you will need to talk to your doctor about medications and supplements you are taking. Your doctor may want you to discontinue taking some of these before the procedure. Additionally, you should arrange for someone to transport you home after the procedure. 1

Blood clotting. Before the liver biopsy is performed, a sample of your blood will be taken to determine how well your blood clots. It is important to make sure that your blood clots normally to prevent bleeding following the biopsy.

Medication list. Make sure you have a list of the medications (including supplements, vitamins, and over-the-counter drugs) that you are taking. It is important to talk to your doctor about whether you should discontinue any medication or supplement temporarily before the biopsy.

Medications to avoid. Typically, a person undergoing a liver biopsy will discontinue taking:

      • Aspirin (or aspirin-containing drugs)
      • Nonsteroidal anti-inflammatory drugs (NSAIDS). These include ibuprofen (Motrin, Advil) and naproxen (Aleve). A variety of non-prescription medications include NSAIDS, so ask your doctor or pharmacist if you are unsure.
      • Warfarin (Coumadin) or other medications that prevent blood clots
      • Some medications used to manage heart conditions, including clopidogrel (Plavix), ticlopidine (Ticlid), abciximab (Reopro)
      • Supplements (herbal and natural products) containing fish oil or ginkgo biloba
      • Vitamin E

Make sure you talk to your doctor first before stopping any medication that you are taking.

Ultrasound. Your doctor may give you a test called an ultrasound before your biopsy. Doing an ultrasound (this is a way of imaging your organs) of the liver and gallbladder will help your doctor locate the correct biopsy site.

Should I eat before my biopsy?

Your doctor may instruct you not eat or drink for 6 hours before your liver biopsy or allow you to have a very light breakfast, such as toast and tea or coffee, before the procedure. Some doctors recommend eating a small amount of fat (butter or margarine) with breakfast. This helps the gallbladder to empty and decreases the risk of injuring it during the biopsy.

What to expect during the procedure

Usually liver biopsies are performed in a hospital outpatient setting. When you arrive for the procedure (usually early in the morning), your doctor or nurse will review your medical history and talk to you about the medications you take and if you are allergic to any medication. An intravenous (IV) line may be placed in a vein in your arm so that fluid or medications can be given to you during the procedure. You may also take medications to minimize any discomfort associated with the procedure as well as to ease any anxiety you feel. You will not be put to sleep during the biopsy, because your active cooperation will be needed. 1

The biopsy itself will take only a few seconds. A shot is given to numb the site at the right side of the ribcage where the biopsy needle will be inserted. You may feel a brief stinging when the medication to numb the tissue is injected. The biopsy needle is inserted through the skin and passed quickly into your liver and then drawn out. Finally, a small bandage will be applied to the site of the biopsy. No stitches will be needed. In some cases, an ultrasound is used during the biopsy to guide insertion of the needle into the liver.

Care following the biopsy

After your liver biopsy, you may be instructed to lie on your right side for a short period of time. During this time, a nurse will monitor your blood pressure and pulse. You can watch TV, read, or talk while you are being monitored. 1

Because you may be taking sedative medications for the liver biopsy, you should have someone present to transport you home when you’re done.

When you return home, you should rest for the remainder of the day and avoid strenuous activities for the next 5 to 7 days. Do not lift more than 15 to 20 lbs for a week after the procedure. Additionally, avoid taking blood-thinning medication for several days after the procedure.

If you experience any of the following symptoms, call your doctor:

  • Pain (severe) at the site of the biopsy or in the shoulder area
  • Bleeding (from biopsy site)
  • Fever (greater than 100.4°)
  • Shortness of breath
  • Chest pain
  • Pain in the abdomen
  • Weakness and sweating
  • Heart palpitations
  • Blood in your stool or black tarry stools

Results of your biopsy

The results from your biopsy should be available within a week of the procedure. Your doctor will schedule a follow-up visit to discuss the results with you.

Complications of liver biopsy

A liver biopsy is generally a very safe procedure, with the most common problems including small decreases in blood pressure and mild pain. Serious complications, such as bleeding, infection, and injury to organs near the liver, are very rare.