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Liver Biopsy

What is a liver biopsy?

A liver biopsy is a procedure in which tissue samples from the liver are removed for examination under a microscope to look for signs of damage or disease. It is used to diagnose many liver conditions. During a liver biopsy, tissue samples are removed with a special needle to determine if cancer or other abnormal cells are present, or to determine how well the liver is working.

There are three types of liver biopsies:

  • Percutaneous or needle biopsy. After deep sedation and local anesthetic is given, the doctor inserts the special biopsy needle into the liver to obtain a sample. Ultrasonography may be used to guide the biopsy needle insertion. Most liver biopsies are performed using this technique. This is usually performed by a pediatric gastroenterologist.
  • Laparoscopic or open biopsy. After a general anesthetic is given, the doctor makes an incision in the skin and surgically removes a piece of the liver. Depending on the lab findings, further surgery may be performed. This is usually performed by a pediatric surgeon.
  • Transvenous biopsy. After a local anesthetic is given, the doctor makes an incision into a vein on one side of the neck and inserts a specially designed hollow tube called a sheath through the vein down to the liver. One or more tissue samples are removed through the tube. This is usually performed by an interventional radiologist.

Other related procedures that may be used to diagnose liver problems include abdominal ultrasound, CT scan of the liver and MRI of the liver. Learn more about these imaging procedures at CHOC.

What are the reasons for a liver biopsy?

A liver biopsy is useful to diagnose conditions of the liver that cannot be determined by symptoms or lab tests. When a person has an enlarged liver, jaundice (yellowing of the skin and eyes due to bile pigments in the blood) or abnormal lab tests that suggest liver disease, a biopsy may be done.

A liver biopsy may be performed to diagnose:

  • Hepatitis. This is inflammation of the liver that sometimes causes permanent damage, resulting from viruses, drugs, alcohol, parasites, or other conditions. Learn more about hepatitis.
  • Liver tumor. An abnormal lump or mass of tissue. Tumors can be benign (noncancerous) or malignant (cancerous).
  • Fatty liver disease. A buildup of fat in liver cells. Learn more about fatty liver disease.
  • Fibrosis of the liver. The growth of scar tissue due to infection, inflammation, injury, or even healing

There may be other reasons for your child’s doctor to recommend a liver biopsy.

What are the risks of a liver biopsy?

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Discomfort and bruising at the biopsy site
  • Prolonged bleeding from the biopsy site, externally or internally
  • Infection near the biopsy site
  • Puncture of adjacent organs or structures.

If the liver biopsy is performed with the aid of X-ray technology, the amount of radiation used is considered minimal. Therefore, the risk for radiation exposure is low.

There may be other risks depending on your child’s specific medical condition. Be sure to discuss any concerns with your child’s doctor prior to the procedure.

Liver Biopsy Procedure Information

Parents are bound to have a lot of questions about how to prepare for and what to expect after their child’s liver biopsy. All liver biopsies at CHOC are performed bedside in the pediatric intensive care unit (PICU) with a PICU physician providing the sedation for the procedure to provide the safest hospital experience possible.

This information is intended for CHOC patients and their families. Always consult your child’s doctor for specific information.

Before the Procedure

  • Your child’s doctor will explain the procedure and offer the opportunity to ask questions about the procedure.
  • A parent (legal guardian) will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your child’s doctor may perform a complete physical examination to ensure your child is in good health before undergoing the procedure. He or she may undergo blood tests or other diagnostic tests.
  • Notify your child’s doctor if your child is sensitive to or are allergic to any medications, latex, tape and anesthetic agents (local and general).
  • Notify your child’s doctor of all medications (prescribed and over-the-counter) and herbal supplements your child is taking.
  • Notify your child’s doctor if your child has a history of bleeding disorders or if they are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen or other medications that affect blood clotting. It may be necessary for your child to stop these medications prior to the procedure.
  • Patients are asked to not eat or drink anything before the procedure, generally after midnight. Your child’s doctor will provide additional instructions as needed such as questions about routine medications the morning of the procedure.
  • Your child may receive a sedative prior to the procedure to help relax.
  • Based on your child’s medical condition, the doctor may request other specific preparation.

During the Procedure

A liver needle biopsy may be performed on an outpatient basis or as part of a stay in the hospital. Procedures may vary depending on your child’s condition.

Generally, a percutaneous (through the skin) liver biopsy follows this process:

  1. Your child will be asked to remove all clothing and given a gown to wear.
  2. Your child will be asked to empty his or her bladder before the biopsy.
  3. An intravenous (IV) line may be started in your child’s arm or hand.
  4. The family will meet with both the sedationist and the gastroenterologist before procedure.
  5. Your child will be positioned on their back with their right arm above his or her head, or on his or her left side.
  6. After all safety precautions have been put into place, the sedationist will then begin administering sedation.
  7. Your child’s doctor will locate your child’s liver by pressing on his or her abdomen and will mark the location where the biopsy will be done. Ultrasound sometimes may be used to locate a specific spot in the liver.
  8. The skin over the liver will be cleansed with an antiseptic solution.
  9. A local anesthetic will be injected with a needle that your child will unlikely feel.
  10. The biopsy needle will be inserted through the skin and into the liver very quickly. Your child will unlikely feel pressure as the needle is pressed into the liver.
  11. The sample of liver tissue will be removed.
  12. There may be more than one insertion performed if your child’s doctor needs more than one tissue sample. If so, the same puncture process will be repeated.
  13. The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site until the bleeding has stopped.
  14. A sterile bandage or dressing will be applied.
  15. The liver tissue sample will be sent to the lab for examination.

After the Procedure

Each patient’s recovery process will vary depending on the type of procedure performed.

  • Your child will be asked to rest quietly for one to two hours, lying on his or her right side in order to apply pressure to the biopsy site. Depending on each child’s condition, some patients may be instructed to continue bed rest for an additional four to 24 hours.
  • A blood sample may be taken a few hours after the procedure to monitor possible internal blood loss and again in the morning.
  • Patients typically remain in the intensive care unit for 24 hours for close monitoring.
  • The bandage should be left in place for as long as instructed (usually until the next day).
  • Your child typically can go home once their vital signs are stable, their pain is under control, they are eating without pain and their blood levels are stable.
  • Your child should avoid strenuous activity, such as heavy lifting for several days up to a week or longer.
  • Your child should not cough hard or strain for several hours after the procedure.
  • The biopsy site may be tender or sore for several days after the liver biopsy. Your child’s doctor will provide information on pain relief before your child is discharged home. Be sure to take only recommended medications.
  • Your child may resume their normal diet unless instructed differently.
  • Your child’s doctor may give you additional or alternate instructions after the procedure, depending on your child’s particular situation.

Notify your child’s doctor of the following:

  • Fever and/or chills
  • Redness, swelling, warmth or bleeding or other drainage from the biopsy site
  • Increased pain around the biopsy site or elsewhere
  • Shortness of breath and/or difficulty breathing.