Liver Biopsy

A liver biopsy is a procedure to collect tiny samples of tissue from the liver with the help of a thin needle. A biopsy test is done to check for liver damage and the extent of it. The tissue samples taken from the liver are studied under a microscope to check for signs of disease or injury. With the help of a biopsy, the doctor can tell us how well the liver is functioning and if there are any abnormal cells in the liver.

In the biopsy, the doctor assesses the stage of liver fibrosis. Fibrosis is scarring or thickening of the liver. Fibrosis has four stages such as F1, F2, F3, and F4:

1. F0 to F1: No or mild scarring of the liver
2. F2: Moderate scarring of the liver
3. F3: Severe scarring of the liver
4. F4: Cirrhosis (advanced scarring of the liver)

A liver biopsy may also be done to check the cause of:

1. Unexplained liver swelling
2. Unexplained skin yellowing (jaundice)
3. An abnormality in the liver that was detected in the computed tomography (CT) scan, ultrasound, or nuclear scan.
4. Abnormal levels of liver enzymes that have been observed in blood tests.
5. Diagnose an underlying liver condition that cannot be otherwise identified.
6. Monitor the liver after liver transplantation.
7. Help in developing a treatment regime based on the state of the liver.

A liver biopsy is performed in the following ways:

1. Transvenous: In this procedure, the doctor inserts a biopsy needle through a jugular vein (a blood vessel in the neck). They then insert a catheter from the neck to the liver to remove the liver sample. This method is used when the patient has an issue with blood clotting, to measure the pressure in the liver, or when there is fluid in the abdomen.
2. Percutaneous: In this method, the doctor inserts a needle through the space between the lower ribs on the right side or through the abdominal wall to reach the liver.
3. Laparoscopic: In this procedure, the doctor makes a tiny cut on the side of the abdomen and inserts a laparoscope (a thin tube with a camera) through it. Further, they place a needle through the cannula (thin tube) to collect liver samples, all visualized continuously with the help of the camera. This procedure is mainly done when the patient has laparoscopic surgery for some other condition and is hardly used for liver biopsy alone.

The following things can happen on the day of the procedure. The patient will be:

1. Instructed not to drink or eat anything for four to six hours before the procedure.
2. Briefed by the doctor regarding the liver biopsy procedure and its complications.
3. Asked to share their queries.
4. Made to wear a hospital gown.
5. Informed to bring along a family member to take them home.
6. Asked for a pre-biopsy blood test before starting the actual biopsy procedure.

The patient will be instructed to lie on their back. The doctor will use an ultrasound to mark the location of the liver. Further steps proceed as:

If a Percutaneous Liver Biopsy procedure is used:

1. The doctor will begin by cleaning and numbing the area with a local anaesthetic.  
2. The doctor will make a tiny cut on the upper abdomen and insert the needle through the cut to collect a small liver tissue sample.

If a Transvenous Liver Biopsy procedure is used:

1. After the patient is told to lie on their back, the doctor will numb the side of the neck with local anaesthesia and make a small cut on the side of the neck.
2. The doctor will then insert a cannula from the neck region to the liver and collect the tissue sample with the help of a needle.

After Liver Biopsy, the patient will:

1. Be kept in the recovery room for about four hours for observation.
2. Told not to drive or operate machinery for at least twelve hours after the biopsy.
3. Told that they may feel a little pain and discomfort in their right shoulder, upper abdomen, or back.
4. Be given pain-relieving medicines.
5. Be told not to do strenuous activity for at least 24 hours after the procedure.
6. Told not to take aspirin, medicines containing aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) such as indomethacin, ibuprofen, or naproxen for three to five days after the biopsy.

Though Liver Biopsy is a safe procedure, sometimes there are a few possible risks and complications involved while performing a liver biopsy:

1. Pain at the biopsy site
2. Bleeding from the biopsy site 
3. Bleeding inside the abdomen around the liver
4. Infection at the biopsy site
5. Injuries to organs such as lung, gallbladder, or small intestine during the surgery
6. Infection leading to sepsis (body’s extreme response to an infection)
7. Haemothorax (blood accumulation in the space between the chest wall and the lung)
8. Pneumothorax (a collapsed lung)
9. Temporary voice issue
10. Temporary facial nerves issue
11. Haematoma in the neck

The patient must contact their doctor if they notice any of the following:

1. Chills
2. Fever
3. Dizziness
4. Difficulty breathing
5. Severe pain or tenderness at the biopsy site or in the shoulder, chest, or abdomen within 72 hours after the biopsy.