Liver Biopsy

 

WHAT IS A LIVER BIOPSY
PREPARATION?
PROCEDURE
RECOVERY
RISKS
ALTERNATIVES
PRE PROCEDURE
POST PROCEDURE
 

In a liver biopsy the physician examines a small piece of tissue from your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged.

Preparation

Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those that affect blood clotting, like blood thinners. One week before the procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants.

You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions.

Procedure

Liver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot. Most patients will receive a small amount of intravenous medication to help relax them or for treatment of any discomfort with the procedure. We do not, however, “knock you out” as we need to have you cooperate with holding your breath at the time of the biopsy (see below).

You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.

Recovery

After the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for 1 to 2 hours. The nurse will monitor your vital signs and level of pain.

You will need to arrange for someone to take you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for 8 to 12 hours, depending on your physician's instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in your right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after the biopsy. These medicines decrease blood clotting and, therefore, can increase the risk of bleeding after the biopsy.

Risks

As with any surgery, liver biopsy does have some risks. These risks include such complications such as accidental puncture of the lung, bowel, or gallbladder; infection, bleeding; and pain. Although very rare, even death can occur due to complications of a liver biopsy. Usually signs and symptoms of these complications appear during the observation period after the biopsy. Treatment of a complication may require hospitalization, blood transfusion, or even surgery. A list of the possible complications and their range of frequencies are listed below:

  • Pain (0.056-22%)
  • Bleeding (0.03%-23%)
  • Bile peritonitis (0.03-0.22%)
  • Severe infection (0.088%)
  • Pneumothorax and/or pleural effusion (0.08-0.28%)
  • Hemothorax (0.18-0.49%)
  • Arteriovenous fistula (5.4%)
  • Subcutaneous emphysema (0.014%)
  • Anesthetic reaction (0.029%)
  • Needle break (0.02-0.059%)
  • Biopsy of other organs
    • Lung (0.001-0.014%)
    • Gallbladder (0.034-0.117%)
    • Kidney (0.096-0.029%)
    • Colon (0.0038-0.044%)
  • Mortality (0.0088-0.3%)

 

Alternatives

Although there are no alternatives to a liver biopsy, there are different methods of obtaining liver tissue. Sometimes a liver biopsy can be performed via the jugular vein in the neck. Access to the liver is via the jugular vein => inferior vena cava =>hepatic vein => liver. This method is usually employed if the patient has an increased risk of bleeding, excessive fluid in the abdomen (ascites) making it unsafe to perform by the abdominal approach, or difficult anatomy/body habitus again making it unsafe to perform by the usual approach. At other times the biopsy is obtained surgically, usually via the laparoscopic approach. This is the preferred approach if there are other reasons for the patient to have a laparoscopy (i.e. removal of the gallbladder, inspection of the peritoneal cavity, etc.)

Pre Procedure

To prepare for your procedure, please follow these instructions carefully:

  1. If your procedure is in the morning, do not eat or drink anything after midnight on the day of the procedure.
  2. If your procedure is in the afternoon, do not eat anything after midnight on the day of the procedure. You may have only CLEAR LIQUIDS until 6 hours prior to your scheduled procedure time. Clear liquids include clear apple/white grape/white pear juice, clear broths, coffee and tea without creamer/milk, Gatorade, Crystal Lite, pop, Jello, and water. AVOID all red and purple juices and Jellos.
  3. Taking your usual medication with small sips of water on the morning of the procedure will be OK. If you are taking diabetes or blood-thinning medications, you should follow the individualized instructions that will be given to you prior to the procedure. Avoid asprin, NSAIDS and ibuprophin 5 days prior to procedure. If you forget and take an aprin product, please contact us imediately as we will need to reschedule your procedure.
  4. You will need to arrange for someone to drive you home as you will be medicated for this procedure. You must have somemone at the faciity to release you after your procedure. For your own safety, you WILL NOT be able to walk home or to take a taxi/bus home.
  5. Please call 541 868-9500 with any questions regarding these instructions, or, in case of emergency to reschedule your procedure. Urgent concerns outside of the office hours should be directed to the on-call physician at 541 868-9500 (toll free 877 484-4501).

Post Procedure

You have just recently undergone a liver biopsy, and in order to keep you safe and healthy we would like you to follow these instructions:

  1. If you were given any medications during your liver biopsy to reduce pain or anxiety you many not drive for a 24-hour period. This is a legal restriction that must be observed. Any narcotics or anti-anxiety medications reduce your reflexes.
  2. You may remove the bandage which covers the liver biopsy site. You do not have to replace it. You may shower or bathe as you desire.
  3. You may have some bruising at the biopsy site. This is to be expected. You may also have some mild discomfort at the biopsy site or deeper within this region. It may feel like you have been punched in your right side.
  4. Upon taking a deep breath you may feel some discomfort in the biopsy area. This is normal for the first 24-48 hours, as long as that discomfort does not exceed what you can comfortably tolerate.
  5. You should not lift any object heavier than 20 pounds for the next three days.
  6. You should not engage in excessive physical activity (jogging, contact sports, etc.) for the next three days. Light exercise such as walking is permissible.
  7. Please do not use any aspirin or pain medications in the class of “non-steroidal anti-inflammatory drugs” (i.e. ibuprofen, Advil, Motrin, Naprosyn, etc.). These products tend to act as blood thinners and we do not want to increase your risk of bleeding from the procedure. If you are taking Coumadin/Warfarin, you will be instructed when to resume this medication.
  8. You may resume your normal regular diet after the procedure.
  9. If you have fever, moderate/severe pain, difficulty breathing, please notify our office immediately at 541 868-9500 (toll free 877 484-4501). We have a doctor on call 24 hours a day. If for some reason you are unable to contact us, you will need to go to the emergency room (or call 911) to be evaluated for these symptoms as a complication of the procedure may have occurred.
  10. Liver biopsy results take approximately 1 week to get back to our office. We will call you at the end of that time with the results. If you do not hear from us by 7 working days please feel free to contact our office.

Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

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