There are many causes of liver disease and it’s sometimes difficult to diagnose a condition based on symptoms and the tests outlined above. Often a liver biopsy is the only way to make a firm diagnosis and identify how advanced the condition is.
A liver biopsy is usually performed in one day and only occasionally requires an overnight stay. Your liver biopsy will be performed by a doctor who may be a gastroenterologist, hepatologist or a radiologist. You will need to give your consent (permission) to the medical staff to carry out the biopsy and a blood sample will be taken to check your blood’s ability to clot.
A local anaesthetic is given to you prior to the liver biopsy procedure. This may be above the liver area on the right side of your abdomen and below the ribs, or more likely between the lower ribs on your right side. In some cases a light sedative can be given if you require it, but discuss this with your doctor.
Sometimes the liver biopsy will be done under ultrasound guidance so that the liver can be seen and the biopsy directed by the imaging. You may already have had an ultrasound performed prior to the biopsy.
When the local anaesthetic has started to work (the area will feel numb), you will be asked to lie on your back or on your side, depending on where the doctors decide to insert the biopsy needle. This is a long thin tube that is inserted through your anaesthetised skin. You may be asked to take a few deep breaths before the needle or biopsy device is inserted and to hold your breath. Once the needle is inserted it is withdrawn quickly to remove a very small sample of liver tissue.
You will then be asked to lie on your right side so that the weight of your body presses on the wound. This is to make sure the wound clots to aid healing. It also means that you will need to remain in bed on your side or on your back for up to six or eight hours so you are advised to go to the toilet before the liver biopsy. There is a very small risk of either internal bleeding or bile leaking from the liver, but this is rare.
You may experience pain or discomfort during or after the liver biopsy. Not all people do, but varying degrees of pain are not uncommon. You should be provided with adequate pain relief after your biopsy, and once you have completed the recovery stage after the liver biopsy you can usually go home.
Your liver biopsy sample is sent to a pathologist (a doctor who identifies diseases by studying cells and tissues) who will examine it under a microscope and produce a report. This may take about two weeks, and you will have an appointment to discuss your results with your specialist who will explain them to you.
Occasionally, if the blood clotting is too prolonged or in the presence of ascites (an accumulation of fluid in the abdomen), it may not be possible to perform a liver biopsy by the conventional route. In these circumstances the liver biopsy may have to be performed via a vein in the neck. This is called a transjugular liver biopsy. This procedure is usually limited to specialist centres and details would be discussed with you by your consultant or their team.
Liver biopsy is considered the best way for diagnosing liver disease, but it’s important to recognise it’s not completely fool-proof.