Table of ContentsView AllTable of ContentsWhy Did My Provider Order a Liver Biopsy?Types of Liver BiopsyPain and Other Risks of Liver BiopsyDay of the Liver BiopsyManaging Pain After Liver BiopsyLiver Biopsy Results and Terms to Know
Table of ContentsView All
View All
Table of Contents
Why Did My Provider Order a Liver Biopsy?
Types of Liver Biopsy
Pain and Other Risks of Liver Biopsy
Day of the Liver Biopsy
Managing Pain After Liver Biopsy
Liver Biopsy Results and Terms to Know
A liverbiopsyis a medical procedure that removes a small piece oflivertissue to be viewed under a microscope to check for signs of liver damage or disease. Several types of biopsies exist. They are usually performed on anoutpatientbasis underlocalorgeneral anesthesia.
Your healthcare provider may order a biopsy if you have signs ofliver disease, including cirrhosis, hepatitis, or liver cancer.A biopsy can also help establish how severe the disease is, what treatments are most appropriate, and how well you are responding to treatment.
The article explains why a liver biopsy may be ordered and what to expect before, during, and after the procedure. It will also walk you through how the results are interpreted on the pathology report.
A liver biopsy can be used to diagnose, evaluate, or manage liver disease or liver damage.
Liver Biopsy
A biopsy may be ordered if a liver problem cannot be definitively diagnosed with blood or imaging tests. Your healthcare provider may recommend the procedure when:
Liver biopsies can also help establish the severity of the disease (referred to as staging) and the rate of disease progression (referred to as grading).
Liver Cirrhosis
Although liver biopsies are used somewhat less frequently today due to advances in noninvasive diagnostic tools such asliver elastography, they remain the gold standard for the diagnosis or staging/grading of many liver conditions, including:
A liver biopsy can also help inform treatment decisions (based on the type, stage, and grade of the disease) and predict the likely outcome of treatment (referred to as theprognosis).This includes the management of the transplanted organ in people who have undergone aliver transplant.
Liver Cancer
The three main types of liver biopsies have specific indications and risks. These types include:
Percutaneous and transjugular biopsies are usually performed withlocal anesthesiathat numbs the biopsy site.
Laparoscopic biopsies are generally performed undergeneral anesthesia(which puts you fully to sleep) ormonitored anesthesia care(which induces what’s known as twilight sleep, anesthesia that makes you insensitive to pain without being unconscious).
What Does a Liver Biopsy Cost?While the price of a liver biopsy can vary based on where you live, a 2018 review inHepatologyreported that costs start at roughly $1,500 for a traditional percutaneous biopsy, soaring into the tens of thousands of dollars for more complex transjugular or laparoscopic procedures.Speak with your insurance provider to understand what your plan covers, including anyco-pay or coinsurancecosts. To better defray expenses, be sure that all of your providers—including youranesthesiologistand treatment facility—arein-network providers.
What Does a Liver Biopsy Cost?
While the price of a liver biopsy can vary based on where you live, a 2018 review inHepatologyreported that costs start at roughly $1,500 for a traditional percutaneous biopsy, soaring into the tens of thousands of dollars for more complex transjugular or laparoscopic procedures.Speak with your insurance provider to understand what your plan covers, including anyco-pay or coinsurancecosts. To better defray expenses, be sure that all of your providers—including youranesthesiologistand treatment facility—arein-network providers.
While the price of a liver biopsy can vary based on where you live, a 2018 review inHepatologyreported that costs start at roughly $1,500 for a traditional percutaneous biopsy, soaring into the tens of thousands of dollars for more complex transjugular or laparoscopic procedures.
Speak with your insurance provider to understand what your plan covers, including anyco-pay or coinsurancecosts. To better defray expenses, be sure that all of your providers—including youranesthesiologistand treatment facility—arein-network providers.
What Are the Risks of Liver Surgery?
Pain
Pain at the biopsy site is the most common complication of a liver biopsy, affecting between 30% and 50% of people who undergo the procedure.However, the pain tends to be mild and readily treated with pain medications.
With a percutaneous biopsy, the pain will often clear within a few minutes or hours. With transjugular and laparoscopic biopsies, the pain may be longer lasting and require stronger medications.
If the pain does not go away or gets worse, call your healthcare provider, as this may be asign of an infectionorinternal bleeding.
Bleeding
Bleeding is a less common complication of a liver biopsy. According to the National Institute of Diabetes and Digestive and Kidney Diseases, only 1 of every 2,500 to 10,000 liver biopsies results in severe bleeding.
To reduce the risk of bleeding, you will be asked to stop certain medications that thin the blood a week or so before the procedure. These include:
Blood Testing Before a Liver BiopsyTo ensure the biopsy can be performed safely, your healthcare provider will order tests to see how well your blood clots, including:Platelet count: This measures how many blood-clottingplateletsyou have in your blood.Prothrombin time (PT): This test measures how long it takes for your blood to clot.
Blood Testing Before a Liver Biopsy
To ensure the biopsy can be performed safely, your healthcare provider will order tests to see how well your blood clots, including:Platelet count: This measures how many blood-clottingplateletsyou have in your blood.Prothrombin time (PT): This test measures how long it takes for your blood to clot.
To ensure the biopsy can be performed safely, your healthcare provider will order tests to see how well your blood clots, including:
Infection
Infection is a rare but possible complication of a liver biopsy. Studies suggest that the risk of infection hovers between 0.01% and 0.1% in people who undergo a percutaneous biopsy.With a laparoscopic biopsy, the risk may be higher ifwound care instructionsare not adhered to.
As with internal bleeding, the risk of infection is largely associated with the accidental puncture of organs such as the colon, lungs, kidneys, liver, or gallbladder.
The accidental puncture of a lung can also lead topneumothorax(a collapsed lung) orhemothorax(the buildup of blood in the space between the lung and chest wall).Both are serious conditions requiring emergency medical treatment.
Know the Signs of Internal Bleeding
You may be asked to stop eating or drinking six to eight hours before the biopsy to avoid vomiting (which can occur with anesthesia or anxiety).Some healthcare providers may allow a little food or liquid beforehand. Double-check to be sure.
A percutaneous liver biopsy usually takes less than 30 minutes to complete (although the actual extraction of tissue takes a few seconds).Because they are more complex and invasive, transjugular or laparoscopic biopsies can take 60 minutes or longer to complete.
Before
You will be asked to change into a hospital gown for the procedure. Your vital signs (including pulse, blood pressure, and blood oxygen) will be taken, and anintravenous (IV) linemay be placed into a vein in your arm to deliver medications, anesthesia, orcontrast dyesfor imaging.
If you are especially anxious, you may be given a low-dose sedative likeAtivan (lorazepam)to help calm you down.
During
A liver biopsy is performed in a procedure room in one of several different ways.
For a percutaneous liver biopsy:
For a transjugular liver biopsy:
For a laparoscopic liver biopsy:
What Are the Risks of General Anesthesia?
After
After the biopsy, you are wheeled into the recovery room where you will be transferred to a hospital bed and monitored for two to four hours. During this time, your vital signs will be regularly checked to ensure there are no signs of internal bleeding (such as a sudden drop in blood pressure).
To better ensure a safe recovery, you would also be positioned in bed in a specific way, as follows:
You may feel a dull ache in your upper right abdomen and lingering pain in your shoulder if you’ve had a transjugular biopsy.
If the pain is severe, let your healthcare provider know. They can recommend medications likeTylenol (acetaminophen)for milder pain or prescribeTylenol 3 (acetaminophen with codeine)for more severe pain.
Before you are discharged, some facilities will want to perform acomputed tomography (CT) scanto check for any signs of internal bleeding. This is especially true if larger samples of tissue were taken.
Once the care team is assured that you are stable and fully recovered from anesthesia, you will be released to return home.
Can I Drive Myself Home?People exposed to general anesthesia or a sedative like Ativan (lorazepam) will need to have someone to drive them home. Others may want to do so just to be safe.Your healthcare provider may also recommend that someone stay with you overnight in case of an unexpected complication.
Can I Drive Myself Home?
People exposed to general anesthesia or a sedative like Ativan (lorazepam) will need to have someone to drive them home. Others may want to do so just to be safe.Your healthcare provider may also recommend that someone stay with you overnight in case of an unexpected complication.
People exposed to general anesthesia or a sedative like Ativan (lorazepam) will need to have someone to drive them home. Others may want to do so just to be safe.
Your healthcare provider may also recommend that someone stay with you overnight in case of an unexpected complication.
Once you’ve returned home, you will need to take it easy for one to three days and avoid exerting yourself for up to one week. This includes avoiding exercise or lifting anything heavier than 10 pounds (including children). Doing so may increase the risk of bleeding or disrupt larger incisions.
You may experience soreness around the incision site for up to a week.While Tylenol can help, you can also apply anice pack or cold compressto the wound for 10 to 15 minutes several times daily. Use a cloth barrier to avoid frostbite or saturating the incision.
Always follow your healthcare provider’s wound care instructions. If you have any problems with healing or your symptoms are not improving, call your provider immediately.
When to Call 911Seek immediate medical help if you have signs of infection or internal bleeding, such as:High fever with chillsIncreasing pain, redness, swelling, or bleeding at the incision siteDizziness, lightheadedness, or faintingSevere abdominal, shoulder, or chest painSudden abdominal swellingNausea and vomitingShortness of breathA racing or pounding heartBloody, black, or tarry stools
When to Call 911
Seek immediate medical help if you have signs of infection or internal bleeding, such as:High fever with chillsIncreasing pain, redness, swelling, or bleeding at the incision siteDizziness, lightheadedness, or faintingSevere abdominal, shoulder, or chest painSudden abdominal swellingNausea and vomitingShortness of breathA racing or pounding heartBloody, black, or tarry stools
Seek immediate medical help if you have signs of infection or internal bleeding, such as:
How to Care for a Surgical Incision
The process, calledhistopathology, involves submitting the sample to various stains and chemicals to look for abnormalities in cells or cell groupings, signs offibrosis(scarring) ornecrosis(tissue death), or the abnormal accumulation of compounds like fat,white blood cells, or toxins.
Based on the findings, the pathologist will issue a pathology report within a few days to a week describing whether or not you have an infection, injury, or cancer of the liver.
If cancer cells are found, the pathology report may include the following information:
Based on these and other findings, your healthcare provider can select the most appropriate treatments specific to your condition, general health, and prognosis.
Summary
METAVIR Scores on a Liver Biopsy
18 Sources
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