A liver biopsy is a procedure in which a very small piece of the liver is removed. The procedure is used to diagnose multiple disease processes, such as hemochromatosis (iron deposits in the liver), liver cirrhosis (scarring of the liver), autoimmune hepatitis, liver cancers, and causes of jaundice (yellowing of the skin and whites of the eyes.)
On the day of the procedure, the patient must be NPO (have nothing to eat or drink) for 10-12 hours before the biopsy. The patient will be given a mild anti-anxiety medication such as Valium or Xanax to assist in making him/her comfortable. Any use of blood thinners such as Aspirin, Plavix, Heparin, or Coumadin must be reported and may require cessation prior to therapy due to potential bleeding risks as well. If taking insulin, the physician may direct that it be stopped for several days prior to the procedure.
The patient will be prepared for the procedure cleaning the area thoroughly with an antiseptic solution. A sterile drape will be placed over the site to avoid infection. If a patient is overweight or has a specific area in the liver to be accessed, an ultrasound may be used to verify liver placement.
A local anesthetic to numb the area will be used at the site with the patient lying flat and right hand behind the head. A small cut will be made at the site and the physician will penetrate the liver will using a Jamshidi needle while the patient is instructed to hold his/her breath. This may be done by hand, or an automatic device may be used to access the liver between the last two ribs on the right side. When the needle is withdrawn, the liver sample is transferred from the core of the needle to the lab to be analyzed. The patient will have a bandage placed and be asked to lie on the right side for 2-6 hours to avoid bleeding.
In some circumstances such as a failed percutaneous biopsy, ascites (fluid in the abdominal cavity) or morbid obesity, the procedure will be completed via the transjugular route. An area over the jugular vein (vein on either side of the neck) will be cleaned with antiseptic and local anesthetic will numb the area. A needle will be inserted into the jugular vein and threaded through to the liver to obtain the sample. A bandage will be applied and the patient may be required to rest quietly for 2-4 hours after the procedure.
Liver biopsy risks include potential bleeding at entry site, puncture of lung or kidneys, as well as internal bleeding. The patient will be monitored closely for complications in the hours after the procedure.