When you have a liver biopsy, small pieces of liver tissue
are removed so they can be sent to a lab
for examination. The appearance of the cells can reveal a great deal about the
health of your liver. Your doctor may
recommend a liver biopsy if other tests have suggested that your liver is not
working properly. Taking a tissue sample using a liver biopsy is the best way
to determine the exact condition of the liver.
Why would I need a liver biopsy?
It may be that you
have had a blood test that revealed elevated levels of liver enzymes or copper
or iron in your system. In some cases, an X-ray may have shown that the liver
is enlarged or inflamed so a liver biopsy is required to discover the nature of
the problem and what is causing it.
A liver biopsy can detect and assess various diseases that
affect the liver including:
- Alcoholic liver disease
- Fatty liver disease
- Raised levels of liver enzymes
- Bile duct obstruction.
- Jaundice
- Haemochromatosis
- Wilson’s disease
- Autoimmune liver disease
- Drug damage to the liver
- Hepatitis B or C: chronic infection with either
of these viruses can lead to liver fibrosis and liver cirrhosis.
- An enlarged or inflamed liver
- Liver cancer
- Liver cysts
A liver biopsy can also help monitor how medicines and treatments
are affecting your liver. If you are being given drugs for diseases such as
chronic viral hepatitis or HIV/AIDS, it is important to make sure your liver is
coping. There is increasing evidence that some of the newer drugs for hepatitis
B can allow the liver to heal and signs of fibrosis regression have been
detected. It is therefore important to have a biopsy every few years to find
out whether this has happened. A liver
biopsy can also be used to detect rejection or infection following a liver transplant.
Having a liver biopsy: before and after
Before the liver biopsy goes ahead you will need a blood
test so that tests can be done to make sure your blood is clotting normally. If
it is not clotting well, you may have problems with bleeding both during the
procedure and afterwards. Your doctor will ask you about any medication you are
taking for stroke prevention, such as warfarin or the newer blood thinners such
as dabigatran (Pradaxa®). You might need to stop taking these for the few days
around your liver biopsy.
The actual liver biopsy is done with a local anaesthetic and
does not take very long; it is not a pleasant procedure but it is not painful
and you should not be uncomfortable. There are three main methods used, which
are described in detail below.
After your procedure, you will need to lie down and relax so
that you can be monitored to make sure the tissues affected by the biopsy are
not going to bleed. Unless your liver biopsy is done first thing in the day,
this might mean an overnight stay in hospital.
What are the risks with a liver
biopsy?
Like any medical procedure that is invasive, liver biopsy
does carry some risks. You may experience some discomfort afterwards, but this
can be managed with painkillers. You may experience a reaction to the local
anaesthetic. More serious but rare complications include having your
gallbladder or lung accidentally punctured, getting an infection, having a lot
of bleeding, and experiencing more than a little pain afterwards.
A percutaneous liver biopsy
If you have a percutaneous liver biopsy, the sample of liver
tissue will be taken by penetrating the skin. Your liver is situated under your
diaphragm and ribs on your right side so when you undergo a liver biopsy you
will need to lie down on your left side so that the doctor doing your biopsy
can insert the needle correctly.
After your skin has been swabbed with antiseptic you will be
given an injection of local anaesthetic to numb the area so that you don’t feel
any pain as the tissue is being removed.
The biopsy is taken using a long, hollow needle which is inserted
into the skin and through to the liver tissue. This should not be painful but
you will have the sensation of pressure as the needle enters the liver. As the
needle is pulled out, it sucks out a small sample of liver tissue that can then
be examined.
A percutaneous liver biopsy with image guidance
During a percutaneous liver biopsy, a real-time ultrasound
scan may be used to guide the needle. This is painless and helps the doctor to
locate the exact site of the liver that he or she wants to investigate.
Having a liver biopsy using laparoscopic
techniques
A laparoscope is a telescope that magnifies the objects it
sees. This is a form of minimally invasive surgery, which can be done to carry
out much more major procedures than a liver biopsy. Four to five ports are made
through the skin of the abdomen and the surgical instruments pushed through
them and used to take the tissue samples. Ultrasound guidance can also be used
to take samples from specific points in the liver.
Alternatives to liver biopsy
It is possible to have a
non-invasive scan that tests the ‘stiffness’ of the liver; different companies
have produced the equipment to do this and although they can detect some
problems, they are not as effective as a liver biopsy. It is likely that the
technology will develop further in the future and the number of people having
liver biopsies could reduce as scanning methods are perfected.
