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Liver Biopsy

Test Overview

A liver biopsy is done using a needle inserted between two of the right lower ribs to remove a sample of liver tissue. The tissue sample is sent to a laboratory and looked at under a microscope to see if there are any liver problems.

A liver biopsy may be done when liver blood tests are abnormal. It may be done when an X-ray, an ultrasound, or a computed tomography (CT) scan shows a problem with the liver. A liver biopsy can also be done to find the cause of jaundice or to check on cirrhosis, hepatitis, or liver cancer.

Why It Is Done

A liver biopsy may be done to:

  • Find the cause of jaundice. A liver biopsy can find certain liver diseases (such as cirrhosis), infections (such as hepatitis), and liver tumours.
  • Find the cause of abnormal blood test results from aspartate aminotransferase (AST) and alanine aminotransferase (ALT) tests. Both ALT and AST levels show liver damage and can help confirm liver disease.
  • See how much the liver is inflamed or scarred by hepatitis or other liver diseases.
  • See whether other liver conditions, such as hemochromatosis and Wilson's disease, are present.
  • Check the response to treatment for liver disease.
  • Determine whether a medicine, such as methotrexate, is causing a toxic effect on the liver.
  • Check the function of a transplanted liver.
  • Find the cause of an unexplained and ongoing fever.
  • Check a liver mass found on an X-ray, ultrasound, or CT scan.

How To Prepare

Before you have a liver biopsy, tell your doctor if you:

  • Are taking aspirin, non-steroidal anti-inflammatory medicines (such as ibuprofen or naproxen), or a blood thinner. You may be asked to stop taking these medicines at least 1 week before the test to lower the chance of bleeding after the test.
  • Are taking any heart medicines.
  • Are using any herbal supplements.
  • Are allergic to any medicines, including anesthetics.
  • Have had bleeding problems.
  • Are or might be pregnant.
  • Have recently had pneumonia, which may make it hard to do this test.
  • Have a history of fluid buildup in the belly (ascites). Ascites may make it hard to do this test.

If you take insulin, check with your doctor about what you need to take on the day of your test.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Arrange for someone to drive you home after the test because you may be given a sedative to help you relax.

You will have blood tests done before the liver biopsy to see whether you have any bleeding or blood clotting problems. You may also have an ultrasound test or CT scan of the liver to check the best place to insert the biopsy needle.

Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be cancelled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .

How It Is Done

A liver biopsy is done by a gastroenterologist, hepatologist, radiologist, or surgeon in a clinic or a hospital. A liver biopsy is often done by a radiologist using ultrasound or a CT scan to help guide the biopsy needle. When cirrhosis of the liver or a cancer is suspected, a liver biopsy may be done during a laparoscopy.

You will need to take off all or most of your clothes. You will be given a cloth or paper gown to use during the test.

Before the test, you may be given a sedative through a vein (IV) in your arm. The sedative will help you relax and remain still.

During the test

During the test, you will lie on your back with your right arm resting under or above your head and your head turned to your left. Your doctor may tap on your chest and belly to find your liver or he or she may use ultrasound.

Your doctor will mark a spot between two of your right lower ribs where the biopsy needle will be inserted. The site will be cleaned with a special soap and draped with sterile towels. The doctor will give you a medicine (local anesthetic) to numb the area where the biopsy needle will be inserted.

You may be asked to take a deep breath, blow all the air out, and then hold your breath while the biopsy needle is being inserted and withdrawn. This will take only a few seconds. Holding your breath lowers the chance that the needle will go in your lung since the lungs are very close to the liver. It is important to remain still during the few seconds it takes for the doctor to collect the tissue sample. The doctor may take another tissue sample from the same spot, but from a different angle.

As soon as the doctor removes the needle, you can breathe normally. A bandage will be put on the puncture site. The test generally takes 15 to 30 minutes.

After the test

You will rest in bed and lie on your right side for 2 to 6 hours after the test. Your pulse, blood pressure, and temperature will be checked often after the biopsy.

You can go home if you have no problems after the test. You may eat your regular diet. But unless your doctor tells you it is okay, do not take aspirin, non-steroidal anti-inflammatory medicines, or blood thinners for one week after the biopsy. You may do your regular activities, but do not do strenuous activities or heavy lifting until your doctor says it is safe.

How It Feels

You may feel a brief sting or burn when the numbing medicine (anesthetic) goes in your skin. When the biopsy needle is inserted, you may again feel a sharp pain for a few seconds.

You may feel deep pressure and a dull pain in your belly when the biopsy needle is inserted. After the anesthetic wears off, you may feel a dull pain in your right shoulder. This is called referred pain and generally goes away in about 12 hours. You can take a non-prescription medicine, such as acetaminophen (Tylenol), for the pain. Call your doctor if your pain gets worse or lasts longer than 2 days.

A small amount of bleeding from the biopsy site can be expected. Ask your doctor how much drainage to expect.

Risks

Serious problems from a liver biopsy are rare. Problems can include:

After the test

After the test, call 911 or other emergency services immediately if you develop:

After the test, call your doctor immediately if you have:

  • A lot of bleeding from the needle site.
  • A fast or skipping heartbeat.
  • A fever.
  • Shortness of breath.
  • Increasing pain at the needle site.
  • Blood in your stool.
  • Swelling or bloating in your belly.

Results

A liver biopsy is done using a needle inserted between two of the right lower ribs to remove a sample of liver tissue. The tissue sample is sent to a laboratory and looked at under a microscope to see if there are any liver problems.

  • Samples of liver tissue sent to a pathology lab will be looked at under a microscope for liver diseases such as liver cancer or cirrhosis.
  • Other samples of liver tissue may be sent to a microbiology lab to see whether an infection, such as tuberculosis of the liver, is present.

Test results are generally ready in 2 to 4 days. If tests are done to find infections, it may take several weeks for the results to be ready.

Liver biopsy

Normal:

The liver tissue looks normal under a microscope. No signs of infection, inflammation, cancer, or cirrhosis are present.

Abnormal:

Abnormal cells or liver tissue are present. This may be caused by an infection such as hepatitis, liver disease such as cirrhosis, or cancer. If liver cancer is present, the biopsy can help find the type of cancer. If hepatitis is present, the test can be used to see the chance of developing cirrhosis. Test results may also show the severity of cirrhosis.

What Affects the Test

Occasionally, a liver biopsy may not provide helpful results because not enough tissue is sampled to make a clear diagnosis.

What To Think About

  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are blood tests done to check liver function. Both ALT and AST levels show liver damage and may be done to help diagnose liver disease. A liver biopsy may be done when AST and ALT levels are very high and no other reason for high levels is found.
  • A liver biopsy should not be done on people who have bleeding or blood clotting problems, or certain types of infections.
  • A transvenous liver biopsy is another method that may be used. During this test, a radiologist inserts a thin tube (catheter) into a neck vein, which is guided to the liver. A sample can be taken through the catheter.
  • If a larger sample of liver tissue is needed, an open biopsy of the liver may be done at another time, using surgery or laparoscopy. A liver biopsy is sometimes done at the same time as another abdominal surgery. To learn more, see the topic Laparoscopy.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Brian D. O'Brien MD - Internal Medicine
Adam Husney MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Michel M. Murr MD - General Surgery, Bariatric Surgery