A liver biopsy involves taking a small piece of liver tissue for laboratory examination. This procedure helps diagnose liver conditions, assess the extent of liver damage, and monitor treatment effectiveness. It is a routine medical test performed to provide precise information about liver health.
Potential Risks and Complications
Pain at the biopsy site is the most common discomfort, often described as mild and manageable with medication. This pain can sometimes radiate to the right shoulder due to irritation of the phrenic nerve, which passes near the liver. Bruising at the biopsy site is also a frequent, minor occurrence.
Bleeding, or hemorrhage, is a more serious, though less common, complication. Significant bleeding requiring a blood transfusion or surgery is rare but remains a concern. Bile leakage can also happen. Infection at the biopsy site or within the abdominal cavity is another rare risk, as bacteria may enter during the procedure.
In very rare instances, the biopsy needle might accidentally puncture a nearby organ, such as the gallbladder, kidney, or lung, potentially leading to a collapsed lung (pneumothorax). Transjugular biopsies, which involve accessing the liver through a vein in the neck, carry additional rare risks like blood collection in the neck (hematoma), temporary facial nerve problems, or short-term voice changes. Overall, serious complications are uncommon, with a life-threatening risk estimated around 0.1%.
Risk Mitigation and Preparation
Before a liver biopsy, medical professionals take several steps to minimize potential risks. Blood tests are routinely performed to assess the patient’s blood clotting ability, including checks for platelet count and international normalized ratio (INR). If clotting issues are identified, medication or a platelet transfusion might be given to reduce the risk of bleeding.
Patients are advised to stop certain medications, such as aspirin, ibuprofen, and blood thinners like warfarin, before the biopsy to lower bleeding risk. Fasting for up to eight hours may also be required, depending on the biopsy type. Imaging techniques like ultrasound or CT scans guide the needle to precisely locate the liver, avoiding injury to other organs.
During the procedure, a local anesthetic is injected to numb the biopsy area, and some patients may receive medication through an IV to help them relax. Medical staff continuously monitor vital signs, and a sterile technique is maintained to prevent infection. The biopsy approach, such as percutaneous (through the skin), transjugular (through a neck vein), or laparoscopic (through a small incision), is chosen based on the patient’s condition. The transjugular method is often preferred for those with bleeding disorders or significant fluid in the abdomen.
Post-Procedure Care and Recovery
Immediately after a liver biopsy, patients are asked to lie on their right side for a few hours to apply pressure to the biopsy site and help prevent bleeding. Throughout this period, medical staff closely monitor vital signs such as blood pressure, pulse, and temperature to detect any signs of complications. Most complications, if they occur, manifest within the first one to three hours after the procedure, or within 24 hours.
Patients can expect some soreness at the biopsy site for a few days, which can be managed with pain medication as directed by their healthcare provider. Patients are advised to avoid strenuous activities, heavy lifting, and vigorous exercise for several days after the biopsy. Showering is permitted after 24 hours, but baths and swimming should be avoided until the site is fully healed.
Watch for signs that warrant immediate medical attention:
Severe or worsening pain not relieved by medication
Fever or chills
Increasing redness, swelling, or drainage from the biopsy site
Difficulty breathing
Signs of internal bleeding, such as black, tarry stools or sudden abdominal swelling
A follow-up appointment is scheduled to discuss biopsy results, which become available within three to seven business days.