This information leaflet has been produced to give you general information and hopes to answer most of your questions about a Ultrasound Guided Liver Biopsy It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have concerns or require further explanation, please discuss this with a member of the healthcare team.
What is a liver biopsy?
A liver biopsy is a procedure for obtaining a small piece of liver tissue. Your liver biopsy sample will be examined under a microscope and a report is produced for your consultant. This usually takes about two weeks, but it could be longer depending upon the findings.
A liver biopsy is considered to be a routine procedure by most specialists, but for a patient about to experience a liver biopsy it can be an anxious and worrying time. This information sheet will help to explain the procedure and answer any concerns you may have, but discussion with your doctors prior to the liver biopsy is also important.
The biopsy is usually performed as a day case and only occasionally does it require an overnight stay. You should bring an overnight bag just in case you do need to be kept in hospital. If you live more than 30 minutes away from the hospital it is recommended that you remain in hospital overnight.
Why am I having a liver biopsy?
Your consultant has recommended that you have a liver biopsy to help assess and diagnose the problem in your liver. There are many causes of liver disease and it is sometimes difficult to diagnose a condition based on symptoms and simple blood tests such as Liver Function Tests (“LFTs”). Often the only way to diagnose a liver disease and identify how advanced it is, is to perform a liver biopsy.
Is there any preparation for the procedure?
Firstly blood samples will be taken to check it is safe to go ahead with the procedure with minimal risks. If the biopsy is being performed as a day-case procedure then you will be asked to attend the Radiology Department for a pre-assessment a day or two before the procedure where these blood tests will be taken. Only if the results are satisfactory will the biopsy proceed. If you are already a patient in the hospital the ward staff will arrange for these blood samples to be taken.
You will be asked to give your consent for this procedure. You will have the opportunity to discuss the liver biopsy with your consultant prior to the biopsy – take the opportunity to ask any questions. If you have any special needs please feel free to discuss these with us.
Will I still take my normal medication?
You will be asked not to take medications that affect blood clotting such as Aspirin, Clopidrogel, Warfarin, Rivaroxaban and Dabigatran for a number of days prior to the biopsy. You will need to discuss your medication with your doctor. This will also be discussed at your pre-assessment appointment. Please let us know as soon as possible (using the number below) if you take any medication to thin your blood.
What will happen when the biopsy is being performed?
You will be brought to the x-ray department on a trolley, and the procedure will be performed whilst you are lying on this trolley.
Your liver is located in the right uppermost part of your abdomen. It also lies under the lower part of your ribcage. The biopsy is obtained by passing a small needle through the skin into the liver. This may be above the site of the liver (on the right side of your abdomen and below your ribs) or more likely between your lower ribs on your right side. The Radiologist (x-ray doctor) performing the biopsy will use an ultrasound machine to locate the area of the liver that they want to take the biopsy from and they will place a mark on your skin to identify it. Depending on where this is you will be asked to lie still in the same position. This may be on your left side or on your back.
The skin over the liver is cleaned with antiseptic and sterile drapes will cover the surrounding area. Local anaesthetic is then injected into a small area of skin and tissue at the site the Radiologist has marked. This stings at first, but then makes the area numb. Once the anaesthetic has had time to work a special hollow needle is pushed through the skin into the liver. You should not feel any pain because of the local anaesthetic however you may feel some pressure as the doctor pushes on the needle.
You will be asked to gently hold your breath for a few seconds. The doctor will tell you exactly when this is because the liver moves slightly when you breathe in and out. As the needle comes out it brings with it a small sample of liver tissue. The radiologist will cover the area with a small dressing. The procedure takes approximately 30 minutes from start to finish.
After the liver biopsy
After the procedure you will return to the ward where the nurses will check your wound, blood pressure and pulse regularly for the next four hours. You will need to stay in bed for this length of time and may be asked to lie on your right side for a while. This is to help the wound stop bleeding as the weight of your body is on the wound. Some patients experience shoulder tip pain following the procedure. The nurses will be able to give you pain relief if this occurs.
You may eat and drink normally.
What are the risks of a liver biopsy?
As with all medical procedures, there are risks involved. The vast majority of patients have no significant problems.
Pain is the most common complication occurring in up to a third of patients. This is usually mild and responds to mild pain relief medication. Moderate and severe pain occurs in less than 3 in 100 patients and can be treated with stronger pain relief.
In a small number of cases there is some bleeding from the biopsy site. This is usually minor and should soon stop.
There is a small risk of either bleeding internally or bile leaking internally from the liver, but this is uncommon and not seen in the vast majority of patients.
Severe complications occur in fewer than 1 in 500 patients. Occasionally the bleeding is more severe and rarely it requires a blood transfusion and, or an operation to manage it. You should discuss risks and complications with your consultant and the doctor performing the biopsy.
Are there any alternative procedures?
There are no alternative procedures to the liver biopsy. You do of course have the choice to not have the biopsy, although you should discuss this carefully with your doctor.
When will I get the results?
The result of the biopsy may take about two weeks. For this reason you will not get your results when you have the biopsy taken. The results will be sent to the consultant who asked for you to have the liver biopsy and they will contact you with the results.
If you have any queries about your biopsy please contact:
If you need to advise following your liver biopsy outside the above hours please contact your General Practitioner.
Reference: British Society of Gastroenterologists Guidelines in Gastroenterology. October 2004.
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.
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