Introduction
A liver biopsy is a procedure by which a thin core of liver tissue is obtained for analysis under a microscope.

Procedure

• Most liver biopsies are done on an outpatient basis i.e. the patient stays in the hospital for half a day.
• The doctor orders tests to check bleeding and clotting times.
• Patient’s blood group is known and blood available if needed.
• All recent medications are reviewed.
Liver Biopsy
• Aspirin and aspirin like medications should have been stopped.
• Under full aseptic precautions the right side of the chest is cleaned and numbed using local anesthesia.
• Breathing techniques are practiced with the patient.
• Using a long fine needle a core of liver tissue is obtained.
• The actual process takes only 1–2 seconds. This process is repeated and another specimen obtained.
• A dressing is applied and the patient lies on his/her right side for about 2 hours and on the back for another 2 hours.
• After about 4–6 hours a blood sample is drawn. If this sample is similar to the one drawn before the biopsy, no bleeding has occurred and the patient is discharged.
• Sometimes a liver biopsy is done by a Radiologist using an ultrasound or CT scan to guide the needle (US or CT guided liver biopsy).
• In patients with a bleeding disorder it can be done by a catheter inserted into a neck vein and advanced into the liver (transjugular liver biopsy).
• The day after a liver biopsy the patient can resume his normal lifestyle.

Indications

• Chronic viral hepatitis like Hepatitis B and Hepatitis C.
• Unexplained liver enlargement and liver tests.
• Alcohol induced liver disease.
• Drug induced liver damage.
• Tumors and cancers.
• Systemic diseases and infections affecting the liver.
• After liver transplantation for rejection and other complications.
• Complications of Liver Biopsy

Complications of Liver Biopsy
Hemorrhage from Needle Biopsy

• Hemorrhage from the liver at the puncture site is frequent and serious complication.
• Bleeding usually is minimal and at short duration.

Hemobilia
Bleeding in the liver from a needle biopsy, may, instead of reaching the peritoneal cavity, enter the biliary tract and escape into the gastrointestinal tract. This is known as hemobilia. It is a rare cause of G. I. bleeding. Early treatment is important since it has a significant mortality if not recognized and corrected.

Hypotension
Ordinarily a sharp drop in B.P. after a needle biopsy of the liver would suggest blood loss. There is often a slow pulse and sharp abdominal pain. It usually lasts an hour or so with recovery.

Bile Peritonitis
Instead of blood, there may be bile leakage from the liver after a needle liver biopsy. Bile escaping into the peritoneal cavity may produce bile peritonitis, with severe abdominal pain, fever and a “Shock–like” state; a situation requiring prompt therapy.

Bleeding
This is an uncommon but serious complication. It is usually controlled by observation and blood transfusion, but may require surgery to stop it.

• Injury to the Gallbladder.
• Bleeding into the bile ducts.
• Injury to the kidney and colon.
• A connection between a vein and an artery called a fistula.
• Irritation of the covering of the lung or liver.