Liver Biopsy

What is a liver biopsy?

A biopsy is the process of collection of a tissue sample from any portion of the body and the examination of the same in a laboratory. The liver biopsy is a medical procedure where a small sample of the liver tissue is collected and examined to look for any traces of damage or disease. The process is used by doctors to study the presence of any abnormal or cancerous cells in the liver. The liver is a vital organ in the body with a variety of important functions ranging from energy production to the storing of vital nutrients and further to the removal of specific waste products. So a healthy liver is essential for survival and biopsy is one of the best options to study critical liver ailments.

What is the main purpose of a liver biopsy?

The most common cause of liver biopsy is to determine the presence of scar tissue in the liver for anyone suffering from a chronic liver disease. It is generally done in those cases which cannot be diagnosed by blood tests or through imaging methods. In some cases the process is essential to confirm a diagnosis before the patient is placed under a specific treatment. The process of biopsy may be guided by an ultrasound or a MRI. The biopsy can be performed in multiple ways and in some cases, a condition might affect one part of the liver more than the rest. The doctor will decide which approach is best for your case depending on the situation.

Why do I need to undergo a liver biopsy?

A liver biopsy is suggested only in specific cases when the treatment or the management of the ailment is dependent on the results. In general, the following are the main situations in which a doctor will order the biopsy.

– Nonalcoholic fatty liver disease or NAFLD, in which fat gets collected in the liver, is one of the most common reasons for a liver biopsy. The biopsy is used to assess the damage caused to the liver.

– To study the damage sustained by the liver in a wide range of diseases like hepatitis B or C, primary biliary cholangitis, primary sclerosing cholangitis, autoimmune hepatitis, hemochromatosis or Wilson’s disease. It can also confirm whether the patient is suffering from one or multiple diseases.

– An injury in the liver or blood tests indicating some abnormality.

– Any abnormal mass of tissue found in the liver from a scan.

– Unexplained enlargement of the liver.

– Any severe case of jaundice.

– Issues with the digestive system or prolonged abdominal pain.

– In order to make a correct diagnosis of the patient’s condition or to confirm a suspicion before subjecting the patient to a long term treatment.

It can also be used as a monitoring tool to ascertain the effectiveness of a particular treatment.

What are the different types of liver biopsy?

Prior to the biopsy, the doctor will look at your blood reports to check whether your blood clots in a normal manner. This is important to prevent any excess bleeding after the procedure. The doctor may also ask for an ultrasound of the liver and gallbladder area to determine the exact site of the biopsy.

In addition, there are also restrictions on the consumption of certain medications, especially the ones that increase the chance of bleeding, before the biopsy. It is important to discuss all the medicines that you are consuming with the doctor before the test.
In general, there are three types of liver biopsies that are conducted.

Percutaneous liver biopsy: In this process, a needle is inserted through the abdominal skin to extract a small section of liver tissue. It is the most common type of biopsy performed and the doctor may take the help of a CT scan or ultrasound to guide the movement of the needle.

Transjugular liver biopsy: For the patients who may have problems with percutaneous liver biopsy, this procedure is followed. The needle is inserted via the jugular vein in the neck and it is passed through the veins to collect a sample from the liver.

Surgical liver biopsy: In this process, the sample is taken from the liver with the help of a surgical procedure. In some cases, a laparoscope that contains a narrow tube with a camera is inserted through an incision made on the body. A needle is inserted through this tube to collect a liver sample.

How is a liver biopsy performed?

The following are the steps followed during a biopsy.

– You will have to put on a hospital gown and will be given a mild sedative to help you relax.

– An IV line can be connected through your wrist if needed for introducing any medication.

– You will lie on your back and the doctor will numb the area with a local anesthetic in the case of a percutaneous liver biopsy.

– A small incision will be made on the skin and a needle will be inserted to collect the liver sample.

– In case of a transjugular liver biopsy the incision will be made on the neck and a tube, followed by a needle, will be inserted.

– You will be expected to lie still throughout the procedure.

– The needle is removed and the site is covered by a sterile bandage.

After the sample is extracted you may need to stay under observation for a few hours. A feeling of pain, discomfort in the site of biopsy, right shoulder or back may be felt. The doctor may prescribe a medication to ease any pain. It is best that you bring along a relative or friend who can accompany you home after the procedure is over.

What is the price for a liver biopsy in India? 

The price of a liver biopsy in India depends on the type of procedure needed. The cost of percutaneous biopsy can vary between Rs 5,000 to Rs 10,000 depending on the place and facilities used. In case it needs to be supported by an ultrasound or a CT scan, the price will be higher. For a transjugular or a surgical biopsy where special equipment is needed, the price can go as high as Rs 30,000 depending on the center.

When will I get the test results?

The results are generally provided within 2 to 3 days. In the case of some complicated cases, it can take up to 7 days.

What is the normal reading for a liver biopsy?

The collected sample will be examined by pathologists for any abnormalities or damages. A normal report will indicate that the liver cells are free from any problem. The details will be mentioned in the report and made available for the doctor to study.

What do the results mean?

Depending on the report, the doctor will offer a diagnosis and will be able to pinpoint a particular condition. The report can also help to ascertain the extent of damage and the liver condition can be graded based on the scale of severity. The doctor will determine the next step of the treatment as needed.

Do I need to fast for the liver biopsy?

Fasting for a few hours is generally necessary before the biopsy and the instructions vary depending on the process followed. You should follow the instructions provided by the doctor.

What else do I need to know before I appear for a liver biopsy?

The following points need to be kept in mind before appearing for a liver biopsy.

– Sometimes pain or minor bleeding may happen after the procedure. In case you experience prolonged pain, fever, abdominal swelling or bloating, dizziness, bleeding from the site or breathing difficulty within 72 hours of the procedure, you need to consult the doctor.

– Complications like infections and injury to internal organs rarely occur during a biopsy. Your blood pressure might be checked and a blood sample taken after the procedure to check for any complications.

– You might be asked not to engage in physical labor, exercise and desist from lifting heavy weights for 1 to 2 days after the biopsy.

– If you have specific allergies, bleeding disorders and consume specific medicines for any particular disease, you should inform the doctor. In case you are pregnant, you need to mention that.

Discuss the details of the benefits, risks, the details of the procedure to be followed along with the restrictions after the biopsy with your doctor.

Can pregnant women undergo a liver biopsy?

Pregnant women can undergo liver biopsy as recommended by the doctor.

Is liver biopsy possible for new-born babies?

New-borns can undergo a liver biopsy as per medical recommendations and with the right safety measures.