Liver biopsy: preparation, how it is done and recovery

A liver biopsy is a medical examination in which a small piece of the liver is removed, to be analyzed under the microscope by the pathologist, and thus, to diagnose or evaluate diseases that are damaging this organ, such as hepatitis, cirrhosis, systemic diseases that affect the liver or even cancer.

This procedure, also called a liver biopsy, is performed in the hospital, as the sample is taken from the liver with a special needle, in a procedure that is similar to a minor surgery and, although rare, there may be some risks, such as bleeding.

Usually the person is not hospitalized and returns home on the same day, although it is necessary to go to the hospital accompanied, because it is necessary to rest and will not be able to drive after the biopsy.

When is indicated

Liver biopsy is used to analyze changes in the liver, in order to define the diagnosis and be able to better plan the treatment. The main indications include:

• Evaluate viral hepatitis B and C, in case of doubts about the diagnosis or severity of the disease, and can also identify the intensity of the damage to the liver. Assess diseases that cause deposits in the liver, such as Hemochromatosis, which causes iron deposition, or Wilson's disease, which causes copper deposit, for example; Identify the cause of liver nodules; Search for the cause of a hepatitis, cirrhosis or liver failure; Analyze the effectiveness of the therapy for the liver; Assess the presence of cancer cells; Search for the cause of a cholestasis or changes in the bile ducts; Identify a systemic disease that is affecting the liver or that causes fever of unclear origin; Analyze the liver of a possible transplant donor or even the suspicion of rejection or other complication after liver transplantation.

This procedure is only performed by medical indication and, usually, only done when other tests that assess the presence of lesions and liver function have failed to provide the necessary information, such as ultrasound, tomography, measurement of liver enzymes (AST, ALT), bilirubins or albumin, for example. Find out more about the liver tests.

How the biopsy is done

To biopsy the liver, a needle is usually used, especially indicated for these cases, in order to try to remove a sample as the least possible damage to the organ.

Some different techniques can be used by the doctor, the most common being percutaneous liver biopsy, in which the needle is inserted through the skin to the liver, which is on the right side of the abdomen. The procedure should be done under anesthesia or sedation and, although it is uncomfortable, this is not an exam that causes a lot of pain.

In general, exams such as ultrasound or computed tomography are used as a guide to locate the area to be reached, from where the sample will be collected. The doctor takes about 3 samples and the procedure takes about half an hour, depending on each case. Then, the samples will be analyzed under the microscope to assess the presence of changes in the cells.

Other ways of obtaining access to the liver for biopsy, is by inserting the needle through the jugular vein and reaching the liver through the circulation, called the transjugular route, or, also during laparoscopic or open surgery, but they are less common.

What preparation is necessary

Before performing a liver biopsy, the doctor may recommend fasting for about 6 to 8 hours. In addition, it is advised to suspend the use of drugs that can interfere with blood clotting, for about 1 week, such as anti-inflammatory drugs, anticoagulants or AAS, for example, which should be done according to medical advice.

How is Recovery

After a liver biopsy, the person needs to remain in the hospital under observation for about 4 hours. The doctor can also check blood pressure and other vital data to see if there are any complications and whether it is safe to be discharged, but generally, people who are well controlled can go home on the same day.

The person must leave the hospital with a bandage on the side of the abdomen that must be removed after 2 days, at home, after a secure healing.

Before removing the dressing, care must be taken not to wet the gauze and check that it is always clean, and if there is bleeding, pus in the wound, fever, in addition to dizziness, fainting or severe pain, it is recommended to go to the doctor for an evaluation.

To relieve pain and discomfort the doctor may recommend that you take a pain reliever, and it is not recommended to make efforts for 24 hours after the procedure.

Possible complications

Although liver biopsy is a safe procedure and complications rarely occur, bleeding, perforation of the lung or gallbladder and infection at the needle insertion site may occur.