Liver biopsy – indications, course of the procedure, possible complications

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An important element in the diagnosis of liver diseases is liver biopsy. This procedure involves taking a piece of liver parenchyma so that the tissue can be examined in a laboratory. No other type of liver test can give you as much information about liver health, so if your doctor suspects you have liver disease, it is very likely that you will be referred for a liver biopsy. Find out what this procedure is about, how to prepare for it and what to do afterwards.

When is a liver biopsy performed?

Contrary to popular belief, the referral to liver biopsy it does not mean that your doctor suspects you have cancer. It’s true that biopsy is essential in the diagnosis of liver cancer, but it is also performed in the following cases:

1. control of the progress of active hepatitis,
2. the occurrence of diseases whose complications may affect the liver,
3. poisoning with toxic chemicals,
4. suspicion of viral hepatitis,
5. increased levels of transaminases in the blood,
6. cirrhosis of the liver, the cause of which cannot be determined by other methods,
7. checking the effectiveness of treating liver diseases.

How do I prepare for a liver biopsy?

There are certain groups of medications that should be discontinued some time before planned liver biopsy:

1. You should stop taking antiplatelet medications at least one week before surgery.
2. Oral anticoagulants with vitamin K antagonist activity should be discontinued 5 days prior to liver biopsy.
3. About two days before the procedure, you cannot take dabigatran anymore.
4. The 24 hours before the liver biopsy is the time when low molecular weight heparin and rivaroxaban should not be taken.

Standard procedure to prepare for liver biopsy includes an ultrasound of this organ, as well as taking a blood sample for complete blood count, liver tests, and blood group determination.

In addition, remember to come to the procedure on an empty stomach and inform the attending physician about any medications you are taking and any chronic diseases you are taking.

How is a liver biopsy performed?

The patient lies on his back during the procedure. First, the doctor taps the right side of the costal arch to determine its location liver. Then an anesthetic is given to block any pain sensation in the skin, the tissue under the skin, and the muscles between the skin and the skin. liver (same liver it is not innervated, so you cannot feel any pain in it). After about 5-10 minutes, the anesthesia takes effect. Then the doctor inserts a syringe with a biopsy needle into the patient’s body. By pulling the plunger of the syringe, it creates a vacuum, thanks to which a sample of the flesh is collected liver. Then the doctor dresses the injection site. The entire procedure takes approximately 20 minutes.

There are two types liver biopsy. Unmarked biopsy consists in inserting a biopsy needle into the area between the 9th and 10th rib, at the level of the right midaxillary line. However, when there is a need for a more precise puncture, e.g. from a fragment of the liver affected by changes, it is performed targeted biopsy with the use of a laparoscope or an ultrasound machine, thanks to which you can precisely control the place of tissue collection.

What after surgery?

Although the procedure itself is short, you should lie still for at least 3 hours afterwards. Then, for about 2-3 days, the patient’s condition is monitored in the hospital. If there were none complications, the patient comes home. Then, for up to a few weeks, you should avoid physical exertion and get plenty of rest. Sick leave after liver biopsy it is usually issued for a period of about two weeks.

Downloaded during biopsy the sample is sent to one of the hepatology centers in the country. There, it is examined microscopically for changes in the structure of cells that may indicate liver disease. The results are expressed in the form of parameters such as inflammatory activity and tissue fibrosis ranging from 0 to 4. In each of these criteria, 0 indicates normal cell structure, and 4 is an advanced disease state. This may or may not be accompanied by the diagnosis of the disease that characterizes the given analysis results. If such a description has not been prepared, the results are interpreted by the physician under whose care the patient is.

What is the risk of complications after a liver biopsy?

Liver biopsy is a relatively safe, routinely performed procedure. The most common complications they result from interference with the body tissues and disappear quickly. These include reactions such as:

1. stomach or shoulder pain
2. a small hematoma on or around the liver,
3. Pressure drop.

The more serious ones are much less common complications. They are already more severe symptoms, among others:

1. formation of a large hematoma inside the liver,
2. extensive hemorrhages,
3. violation of adjacent organs with a needle,
4. formation of a veno-arterial fistula inside the liver.