Liver Biopsy

Liver Biopsy

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.
 

Description of procedure

A liver biopsy involves the surgeon removing a small piece of your liver (about 1/50,000th of your liver) to send for further tests. Most liver biopsies are examined under the microscope by a pathologist. Sometimes, a piece of liver is sent to microbiology to see if there is any infection in the liver. Your doctor will explain to you why he/she thinks you need a liver biopsy. A liver biopsy may be done to look for the cause of liver abnormalities, to assess if, and how much, the liver is damaged and/or to help in planning treatment.

You will need to be in hospital for at least 4-6 hours after the biopsy. This may require admission either overnight or may be done as a day case. Before the liver biopsy is done, the doctor or nurse will check your blood to make sure that clotting is within acceptable limits. If you are taking certain medicines, drugs or tablets that may affect bleeding and clotting you may be asked to stop them for a few days or a week or two before the biopsy. Sometimes, perhaps because of liver disease, the blood does not clot as well as is needed and you may be given some blood factors (plasma) to help your blood clot. Sometimes you may also need platelets to be given. If it is unsafe the doctor will not proceed with the biopsy.

You can ask the surgeon about having sedation before the biopsy. In order to give injected sedation, an extra nurse or doctor needs to be present to give you the injection and monitor you during the procedure therefore telling us in advance will help us plan for this. You may also be able to take a ‘relaxing’ tablet by mouth before the procedure.

Operative techniques

Most biopsies are now done with an ultrasound so you will be taken to the imaging department on your bed or trolley. During the biopsy, you will have to lie flat on your bed or trolley. The ultrasound will be used to show the doctor exactly where your liver is and the best place for the biopsy. The liver is normally situated on your right side just under the lower ribs. Biopsy is often taken here or in the front at the top of your tummy. The doctor will explain the procedure to you before doing the actual biopsy.

The doctor will put some disinfectant on your skin and then inject a local anaesthetic. This may sting before the skin goes numb. You may also feel the local anaesthetic deeper inside before it works. It takes a few minutes to have its full effect.

The doctor will then take the biopsy. This usually takes only a few seconds. You will be asked to hold your breath for a few seconds while it is being done. Sometimes we need to take 2 or 3 samples to be sure to have enough to analyse.

When the biopsy is done, a plaster will be put on your skin at the biopsy spot. You will have to lie on the bed or trolley for at least 6 hours. During that time, the nurse will take your blood pressure and pulse. This will be every 15 minutes for the first 2 hours, then less frequently. You will be able to eat and drink a little during this time.

Alternative procedures/conservative measures
  • The vast majority of liver biopsies are done without any complication. The most common complication is pain and this can usually be controlled with pain killers. Bleeding is a potential problem, and for this reason the doctor will check that your blood clots normally and the nurse will take your blood pressure and pulse after the procedure. Bleeding may affect 1 in 200 liver biopsies.
  • Often this settles by itself, but we know that 1 in 4 patients who bleed may require a blood transfusion. Very rarely (perhaps less than 1 in 500 of the patients who have this problem) an operation is required to stop the bleeding.
  • As the doctor is unable to see the whole liver when performing a biopsy, there is the possibility that the needle might injure other organs, such as the gall bladder or, very rarely, the kidney or bowel. This happens in less than 1 in 1000 cases. Sometimes, needle injury to other organs does cause problems, however very severe complications are extremely rare.
Follow-up or need for further procedure
  • After the liver biopsy, you will need to stay in your bed for 4-6 hours, then if everything is satisfactory you may be free to go home. Please arrange for someone to collect you on discharge rather than drive yourself. You must have a responsible adult with you on the first night following your biopsy and be within a 30 minute drive from a hospital. If you have received sedation you should not drive or operate machinery for 36 hours. If you have any discomfort you can usually take paracetamol, but, if the pain is severe, let the hospital know.
  • Please ask about what arrangements will be made for you to be informed of the biopsy report. It is important that you do not do anything strenuous within 36 hours after liver biopsy. If you have any pain or any other untoward effect, which may be related to the liver biopsy please contact us immediately.

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