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How is a Liver Biopsy Done?

doctor performing a liver biopsy

During a liver biopsy, a small part of liver tissue is removed, which allows a laboratory to inspect it for damage. There are three main types of liver biopsies, which are the percutaneous, the transvenous and the laparoscopic biopsy. If a doctor suspects there is a problem with the liver but is unable to diagnose this through imaging scanning or through blood tests, a regular biopsy may be requested. More often than not, this is done to assess how much damage exists in the liver, which is known as staging.

This, in turn, helps to guide the necessary treatment. In all three of the biopsy types, some of the tissue is removed through a needle. The difference between the three is found mainly in how the needle is inserted. More often than not, a biopsy is performed on an outpatient basis. Let’s take a look at each liver biopsy procedure.

Percutaneous Biopsy
This is the most common type of biopsy. Here, a hollow needle is sent through the abdomen until it reaches the liver, and a small piece is removed. This is also known as a CT scan liver biopsy, because a continuous CT scan is needed in order to make sure no other organs are hit by the needle. Some doctors prefer using ultrasound, which displays images on a monitor present in the operating room. Others prefer CT scans, as these take various x-ray pictures of the different part of the body, giving something close to a 3D image. There are a few doctors would tap the abdomen in order to find the liver.

During this procedure, patients are asked to lie on their back and they rest their right hand over their head. An anesthetic is put on the area of the liver, although some will be given an IV with constant pain medication. A small incision is then made, generally just below the rib cage, and the biopsy needle is inserted. During this procedure, a patient will need to exhale and keep their lungs empty until the sample is withdraw, which only takes a few seconds. Sometimes, multiple samples are collected. Patients then have to lie on their right for around 2 hours, so that bleeding does not occur. They tend to have to stay in hospital for around two more hours before being allowed home.

Transvenous Biopsy
This is offered to patients who have blood that clots slowly, or who have ascites, which is where excess fluid has accumulated in the abdomen. The same position is used to perform the procedure. However, here, an incision is made in the neck and a sheath is then inserted into the vein in the neck, which is the jugular vein. The sheath is then pushed down, past the heart, until it reaches the liver. The sheath is injected with a contrast material, to make sure the doctor is able to track the path. After this procedure, patients continue to be monitored for around six hours.

Laparoscopic Biopsy
This is the most common biopsy used on suspected cancer or infection patients. It allows for multiple samples to be taken without any risk of infection or spreading of the cancer. A number of small incisions are made, and various highly specialized tools, including a camera, are passed into these incisions. Most often, patients are put under general anesthetic during these procedures. After the first incision, the doctor will fill the abdomen with gas so it extends and allows the doctor room to maneuver. Patients tend to have to stay in hospital for a few hours after they have woken up.

Liver Biopsy Results
It generally only takes a few days for the results of tests following a liver biopsy to be returned. The tissue is first stained in a pathology lab, which highlights the various details in the tissue. This, in turn, helps to identify whether there is any diseases present. A liver biopsy report is then sent to the doctor, who informs the patient in turn.

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