Article updated and reviewed by Sreeni Jonnalagadda, MD, Associate Professor of Medicine, Interventional and Pancreatobiliary endoscopy, Washington University School of Medicine on May 2, 2005.
A liver biopsy is a procedure to obtain a sample of liver tissue for analysis and diagnosis of liver diseases.
Indications for a liver biopsy
A liver biopsy is performed to evaluate elevated liver enzymes with the goal of confirming, excluding or assessing the severity (staging) of liver disease. Occasionally it may be performed to diagnose abnormalities in the liver seen on imaging studies such as ultrasonography, CT scans or mri scans. Common clinical problems requiring a liver biopsy are infectious hepatitis (hepatitis b and C) and fatty liver. Less commonly, a liver biopsy may be performed to evaluate autoimmune hepatitis, iron or copper overload, liver mass, medication related liver problems and in following a liver transplant patients.
The liver biopsy can be performed through the skin (percutaneous), via major blood vessels that pass through the liver (transjugular) or during abdominal surgery.
The percutaneous approach is the most common means of obtaining a sample of liver tissue. The procedure is typically performed in the outpatient setting. Ultrasonography may be used to locate a good site for biopsy. The chosen site is numbed with local anesthetic and tissue sample is obtained with a long needle passed into the liver. The actual biopsy portion of the procedure takes several seconds. If the goal is to obtain tissue from a particular abnormal area, the biopsy can be performed under the guidance of either ultrasound or computed tomography (ct scan).
In patients who cannot have a percutaneous biopsy due to tendency to bleed excessively, inability to identify a good site for percutaneous biopsy, marked obesity or a few other indications, liver tissue can be obtained via a catheter that is passed into the a large vein in the neck and advanced to the liver.
A sample of liver tissue can also be obtained during laparoscopic or open abdominal surgery.
The tissue obtained undergoes special staining procedures. Subsequently the pathologist renders a diagnosis after microscopic examination.
A liver biopsy can occasionally result in complications. Risks include injury to surrounding organs, bleeding or a bile leak and may require observation in the hospital.
Why is a liver biopsy indicated?
What is the purpose of the biopsy?
What abnormalities are suspected?
How will the biopsy be performed?
What is the risk of complications?
How reliable are the results of a liver biopsy?
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