It's normal to feel a little scared and nervous when your doctor tells you to "take a small piece of your liver for testing" (Liver Biopsy). Who doesn't like hearing the words "sticking a needle," right? But this is actually not as scary as we think. This can help you find out exactly what's wrong with your liver. So let's talk about this simply from the beginning.
What is a liver biopsy?
Simply put, a liver biopsy is a procedure where a very small piece of tissue (tissue sample) is removed from your liver using a special needle. This tissue sample is then examined under a microscope by a doctor who specializes in tissue, called a pathologist. This test can help identify exactly what kind of disease your liver has.
Most of the time, you are completely anesthetized, meaning you are not put to sleep. However, if you are nervous or anxious, you may be given a sedative (medication) to help you relax. This will allow you to do this without feeling too uncomfortable.
Why do you need a liver biopsy?
A doctor may refer you for this test for several reasons.
- If your blood test results show persistently abnormally high liver enzymes.
- If your skin has turned yellow for no apparent reason, it means you have jaundice.
- If a scan of your liver (such as an ultrasound or CT scan) shows something wrong with it, such as a tumor,
- If the liver is swollen and enlarged for no reason.
This test can accurately diagnose a number of liver-related diseases. For example:
- Liver cancer
- Fatty liver disease
- See how serious conditions like Hepatitis B and C are
- See if the liver has developed cirrhosis, and if so, to what extent.
Also, if someone is already receiving treatment for a liver disease, this biopsy test can help determine whether the treatment is successful.
Does this really hurt?
This is the biggest question on everyone's mind. It's normal to think of pain when you hear the word "sticking a needle and taking a piece." But the truth is, you don't feel any pain when the biopsy needle is inserted into the liver.
The doctor will first inject a local anesthetic into the area of skin where the needle will be inserted. This is similar to numbing the gums before a tooth is extracted. You may feel a slight burning sensation when the injection is given, but the area will be completely numb within a minute. Then, when the biopsy needle is inserted, you will feel only a slight pressure, not pain.
What are the methods for performing a liver biopsy?
There are several ways to perform a liver biopsy. Your doctor will decide which method is best for your situation.
| Biopsy method | How to do it simply |
|---|---|
| Percutaneous Biopsy | This is the most commonly used and simplest method. After numbing the skin, a needle is inserted through the skin of the abdomen into the liver and a piece of tissue is taken. |
| Plugged Biopsy | Same as above, but after the tissue is removed, the needle is plugged with a special gel. This method is used for people who are at high risk of bleeding. |
| Laparoscopic Biopsy | A very small incision is made in the abdomen, and a tube with a camera (laparoscope) is inserted. The camera looks at the liver and takes a piece of tissue from the desired area. You will be fully anesthetized for this. |
| Transvenous / Transjugular Biopsy | This method is used for people with blood clotting problems. A very thin tube (catheter) is passed through a large blood vessel in the neck (jugular vein) into the liver, and a biopsy needle is passed through that tube to take a piece of tissue. |
How should I prepare before a biopsy?
There are a few things you need to do before this test. It is very important that you follow these exactly.
- Tell your doctor everything: If you are pregnant, have heart or lung disease, have allergies to certain medications, or have bleeding problems, tell them all in advance.
- Tell us about all the medicines you take:Tell your doctor about all the medications, vitamins, and supplements you take. It's especially important to tell your doctor if you're taking blood thinners, such as aspirin, clopidogrel (Plavix), warfarin (Coumadin), or apixaban (Eliquis) . Your doctor may ask you to stop taking these medications a few days before the biopsy.
- Ask questions: Talk to your doctor about any questions or concerns you may have about this.
- Stopping eating and drinking: Your doctor will tell you how many hours before the biopsy you should stop eating and drinking. Follow that time exactly.
- Someone to drive you home: Since you will not be able to drive yourself after the biopsy, bring someone to drive you home.
What happens on the day of the biopsy?
This process usually goes like this.
Before the biopsy
The doctor will explain the entire procedure to you again, tell you about possible complications, and get your consent. If necessary, they will give you sedation to help you relax. They may also perform an ultrasound to find the right place to insert the needle.
When the biopsy is done
You will be given a hospital gown and asked to lie down on a bed. Often, you will be asked to lie down with your right arm under your head and your right elbow out. It is important to remain as still as possible during this time. The doctor will clean the area, administer a numbing medication, make a small incision, insert a biopsy needle, and within a few seconds, remove a piece of tissue. The entire procedure takes about 15-30 minutes.
After the biopsy
You will then be kept in a recovery room for about 2-4 hours to check if your blood pressure and pulse are normal.
- You may feel a little soreness at the injection site, and some pain in your shoulder or back. Painkillers will be given if necessary.
- Avoid heavy lifting or strenuous exercise for a week after the biopsy.
- Do not take blood thinners such as aspirin without your doctor's advice. You can take paracetamol (acetaminophen) if necessary.
- The doctor will explain it to you when he receives your test report in a few days.
Are there any risks in this?
Most of the time, there are no complications. However, it's good to be aware of the very rare things that can happen.
- Bleeding: You may be bleeding internally. You will be monitored in the hospital to check for this.
- Bile leak: Bile can leak from the liver or gallbladder.
- Lung-related problems:Very rarely, the biopsy needle can hit the pleura, damaging the lung (pneumothorax).
If you have these symptoms, call your doctor immediately or go to the ETU.
If any of the following symptoms occur within 72 hours of the biopsy, call your doctor immediately, or go to the Emergency Department (ETU) of the nearest hospital.
- Fever or chills
- Dizziness
- Difficulty breathing
- Chest pain
- Abdominal bloating or fullness
- Increasing stomach pain
- Redness, swelling, and severe pain at the puncture site
If you experience chest pain or difficulty breathing, call 1990 immediately.
Take-Home Message
- Liver Biopsy is a very safe and commonly performed test that accurately assesses the health of your liver.
- Because the skin is numbed when you do this, it doesn't feel as painful as you might think. You just feel a slight tingling sensation.
- It is very important for your safety to follow the doctor's instructions carefully before and after the test.
- If any unusual symptoms (fever, severe pain, difficulty breathing) occur after the test, seek medical advice without delay.
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