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 tumors.
  • 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,
    nonsteroidal 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 canceled. 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 (What is a PDF document?).

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,
nonsteroidal 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 nonprescription 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

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Specialist Medical Reviewer Michel M. Murr, MD – General Surgery, Bariatric Surgery

Current as ofOctober 9, 2017