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Liver Biopsies

What is a liver biopsy?

Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue, which can be examined under a microscope to help identify the cause or state of liver disease.

What are the different ways liver biopsy can be performed?

The most common way Dr. Galati performs a liver sample is obtained  by inserting a needle into the liver for a fraction of a second, making use of a special needle. This is usually performed as an outpatient and the patient is sent home after 4-6 hours of observation if there are no problems. Patients are sedated and relaxed with a combination of medications, including propofol, creating a very relaxed state. Dr. Galati determines the best site, depth and angle of the needle puncture by physical examination and the use of ultrasound. The skin and area under the skin is anesthetized, and a needle is passed quickly into and out of the liver. The majority of the  individuals have no pain afterwards, while a small percentage will experience brief localized pain that may spread to the right shoulder. Patients are able to return to work the next day following a biopsy in most situations.

When is a liver biopsy used?

Liver biopsy is often used to diagnose the cause of chronic liver disease that results in elevated liver tests or an enlarged liver. It is also used to diagnose liver tumors identified by imaging tests, such as ultrasound or cat scans. In many cases the specific cause of the chronic liver disease is suspected on the basis of blood tests, but a liver biopsy is used to confirm the diagnosis as well as determine the amount of damage to the liver. Liver biopsy is also used after liver transplantation to determine the cause of elevated liver tests and determine if rejection is present. Liver biopsies are vital in determining the extent of damage due to hepatitis C, fatty liver, and to assist in the decision to treat.

What are the dangers of liver biopsy?

The primary risk of liver biopsy is bleeding from the site of needle entry into the liver, although this occurs in less than 1% of patients. Other possible complications include the puncture of other organs, such as kidney, lung or colon. Injury to the gallbladder, a structure close to the liver maybe associated with leakage of bile into the abdominal cavity, causing abdominal pain peritonitis (inflammation of the abdomen). Fortunately, the risk of death from liver biopsy is extremely low, ranging from 0.1% to 0.01%. To reduce the risk of bleeding, medications such as aspirin, ibuprofen, Advil, Motrin, NSAIDS, heparin, warfarin, Plavix, or other blood thinners need to be stopped days to weeks before the biopsy. Fish oil supplements also decrease the ability to form a clot, increasing the chance of bleeding. Discuss these medications with Dr. Galati prior to scheduling the biopsy with the staff. If you have any questions about your medications or supplements, ask Dr. Galati and his staff.

Do liver biopsies ever need to be repeated?

In most circumstances, a liver biopsy is only performed once to confirm a suspected diagnosis of chronic liver disease. Occasionally, liver biopsy is repeated if the clinical condition changes or to assess the results of medical therapy, such as drug treatment of chronic viral hepatitis C with interferon or prednisone therapy for autoimmune hepatitis. Patients who have undergone liver transplantation often require numerous liver biopsies in the early weeks to months following the surgery to allow accurate diagnoses of whether the new liver is being rejected or whether other problems have developed. There is no danger with multiple biopsies, outside of the individual risk at the time of each biopsy.