Liver biopsy

• Alternative Names

  Biopsy - liver; Percutaneous biopsy

• How the test is performed

  The test is usually done in the hospital. You may be given a medication to calm you (sedative) or pain medication by injection before the test. If the biopsy is done through the abdominal wall, you will be lying on your back with your right hand under your head. It is important to be as still as possible.

  The health care provider will examine the liver and determine the correct spot for the biopsy needle to be inserted. The skin will be cleansed, and a small needle will be used to inject a local anesthetic to numb the area. A small cut is made, and the biopsy needle is inserted. You will be instructed to hold your breath while the biopsy is taken. This is to reduce the chance of puncturing the lung or tearing the liver.

  The needle is inserted and removed quickly. Pressure will be applied to stop the bleeding. A bandage is placed over the insertion site. Ultrasound is usually used to guide the needle.

  The procedure can also be performed by inserting a needle into the jugular vein. If the procedure is performed through the jugular vein, you will lie on your back on a table.

  The internal jugular vein in the neck will be located. The skin will be cleansed, and a small needle will be used to inject a local anesthetic to numb the area. A needle is then inserted to pass a catheter through the veins to the liver. X-ray equipment will be used to check the location of the catheter. A specialized needle is then used through the catheter to take the biopsy sample.

  If you receive sedation for this test, you will need someone to drive you home.

• How to prepare for the test

  Tell your health care provider about:

  • Bleeding problems
  • Drug allergies
  • Medications you are taking
  • Whether you are pregnant

  You must sign a consent form. Blood tests are sometimes done to test your blood's ability to clot. You will be told not eat or drink anything for the 8 hours before the test.

  For infants and children:

  The preparation you can provide for this test depends on your child's age and experience. For specific information regarding how you can prepare your child, see the following:

  • Infant test or procedure preparation (birth to 1 year)
  • Toddler test or procedure preparation (1 to 3 years)
  • Preschooler test or procedure preparation (3 to 6 years)
  • School age test or procedure preparation (6 to 12 years)
  • Adolescent test or procedure preparation (12 to 18 years)
• How the test will feel

  You will feel a stinging pain from the anesthetic needle and when the anesthetic is injected. The biopsy needle may feel like deep pressure and dull pain. Some people feel this pain in the shoulder.

• Why the test is performed

  The biopsy helps diagnose many liver diseases. The procedure also helps assess the stage (early, advanced) of liver disease. This is especially important in hepatitis C infection.

  The biopsy also helps detect:

  • Cancer
  • Infections
  • The cause of abnormal levels of liver enzymes that have been found in blood tests
  • The cause of an unexplained liver enlargement
• Normal Values

  The liver tissue is normal.

• What abnormal results mean

  The biopsy may reveal a number of liver diseases, including cirrhosis, hepatitis, or infections such as tuberculosis. It may also indicate cancer.

  This test also may be performed for:

  • Alcoholic liver disease (fatty liver, hepatitis, or cirrhosis)
  • Amebic liver abscess
  • Autoimmune hepatitis
  • Biliary atresia
  • Chronic active hepatitis
  • Chronic persistent hepatitis
  • Disseminated coccidioidomycosis
  • Hemochromatosis
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatocellular carcinoma
  • Hodgkin's lymphoma
  • Non-alcoholic fatty liver disease
  • Non-Hodgkin's lymphoma
  • Primary biliary cirrhosis
  • Pyogenic liver abscess
  • Reye syndrome
  • Sclerosing cholangitis
  • Wilson's disease
• What the risks are
  • Collapsed lung
  • Complications from the sedation
  • Injury to the gallbladder or kidney
  • Internal bleeding
• References
  Bergasa NV. Approach to the patient with liver disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 149.

Review Date: 3/5/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Francisco, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.