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By Mayo Clinic staffPercutaneous liver biopsy, the most common type, isn't an option for some people. Your doctor may use a different form of liver biopsy if you:
- Could have trouble holding still during the procedure
- Have a history of or likelihood of bleeding problems or blood-clotting disorders
- Might have a tumor involving blood vessels in your liver
- Have an abnormal amount of fluid in your abdomen (ascites)
- Are very obese
- Have a liver infection
If you aren't a candidate for percutaneous liver biopsy, you may have a transjugular liver biopsy, also called transvenous liver biopsy. Laparoscopic liver biopsy isn't used often, but may be recommended if you have cancer, an infection, a mass in your abdomen or ongoing abdominal pain. Laparoscopic biopsy allows your doctor to obtain tissue samples from a larger or more targeted area.
Before the procedure
A liver biopsy is done at a hospital or outpatient center. You'll likely arrive early in the morning. Your health care team will review your medical history, including the medications you take.
Just before your biopsy you will:
- Undress and put on a hospital gown
- Have an intravenous (IV) line placed, usually into a vein in your arm, so that you can be given medications if you need them
- Possibly be given a sedative to help you relax during the procedure
- Use the toilet if needed, because you'll need to remain in bed for at least three hours after the procedure
During the procedure
Before or during liver biopsy, your doctor might use ultrasound to help locate the liver and mark the place to insert the needle. Some doctors locate the liver by tapping on the abdomen (percussion). In certain situations, ultrasound might be used during the biopsy to guide the needle into your liver.
The steps involved in liver biopsy vary according to the type:
- Percutaneous biopsy. You'll lie on your back on a table with your right hand resting above your head. Your doctor will apply a numbing medication (local anesthetic) to the area where the needle will go in. The doctor then makes a small incision in your abdomen, near the bottom of your rib cage, and inserts the biopsy needle. The biopsy itself takes just a few seconds. As the needle passes quickly in and out of your liver, you'll be asked to exhale and hold your breath. A small bandage will be placed on the incision — no stitches are needed.
- Transjugular biopsy. You'll lie on your back on an X-ray table. Your doctor applies a numbing medication to one side of your neck, makes a small incision and inserts a flexible plastic tube (catheter) into your jugular vein. The tube is threaded down the jugular vein and into the large vein in your liver (hepatic vein). Your doctor then injects a contrast dye into the tube and makes a series of X-ray images. The dye shows up on the images, allowing the doctor to see the hepatic vein. A biopsy needle is then threaded through the tube, and one or more liver samples are quickly removed. The catheter is carefully removed, and the incision on your neck is covered with a bandage. Transjugular biopsy takes 30 to 60 minutes.
- Laparoscopic biopsy. During general anesthesia, you'll lie on your back on an operating table, and your doctor will make one or more small incisions in your abdomen. A plastic tube-like instrument called a cannula is then inserted into the incision, and your doctor pumps gas into your abdomen to inflate it. Using special tools, including a lighted video camera, the doctor inserts a needle through the tube to remove liver samples. Then the tube is removed, and the incision is closed with stitches that later dissolve.
After the procedure
After the biopsy, you can expect to:
- Be taken to a recovery room. A nurse will monitor your blood pressure, pulse and breathing.
- Rest quietly for two to four hours, or longer if you had a transjugular procedure.
- Be given written instructions about your recovery.
- Feel some soreness where the needle was inserted. This may last up to a week.
Someone else should drive you home. Most people get back to their usual activities within a day or two after a liver biopsy. Avoid lifting more than 10 to 15 pounds for at least 24 hours. Your liver tissue goes to a laboratory to be examined by a doctor who specializes in diagnosing disease (pathologist). The pathologist will look for signs of disease and damage to the liver.
Call your doctor if you experience:
- Severe pain at the biopsy site or in your shoulder
- Shortness of breath
- Chest pain
- Bleeding from the biopsy site
- Fever over 100.4 F (38 C)
- Abdominal pain
- Weakness, lightheadedness or sweating
- Heart palpitations
- Bravo A, et al. Percutaneous liver biopsy. http://www.uptodate.com/home/index.html. Accessed Sept. 18, 2009.
- Liver biopsy. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/liverbiopsy/. Accessed Sept. 18, 2009.
- Rockey DC, et al. Liver biopsy (AASLD position paper). Hepatology. 2009;49:1017.
- Sanchez WS, et al. Liver cirrhosis. American College of Gastroenterology. http://www.acg.gi.org/ patients/ gihealth/ pdf/ livercirrhosis.pdf 44k 08/Jan/2009. Accessed Sept. 18, 2009.
- Liver biopsy. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec03/ch023/ch023d.html. Accessed Sept. 18, 2009.
- Chopra S. Patient information: Liver biopsy. http://www.uptodate.com/home/index.html. Accessed Sept. 18, 2009.
- Bravo A, et al. Transjugular, laparoscopic, and fine needle aspiration liver biopsy. http://www.uptodate.com/home/index.html. Accessed Sept. 18, 2009.
