How the test is performed

The test is usually done in the hospital. Before the test is done, you may be given a medicine to prevent pain or to calm you (sedative).

If the biopsy is done through the abdominal wall, you will be lying on your back with your right hand under your head. It is important to be as still as possible.

The health care provider will determine the correct spot for the biopsy needle to be inserted into the liver. The skin will be cleansed, and a small needle will be used to to inject medicine to numb the area. A small cut is made, and the biopsy needle is inserted. Ultrasound is usually used to guide the needle.You will be told to hold your breath while the biopsy is taken. This is to reduce the chance of puncturing the lung or tearing the liver.

The needle is removed quickly. Pressure will be applied to stop the bleeding. A bandage is placed over the insertion site.

The procedure can also be done by inserting a needle into the jugular vein. If the procedure is performed this way, you will lie on your back. X-rays will be used to guide the health care provider to the vein. A special needle and catheter (thin tube) is used to take the biopsy sample.

If you receive sedation for this test, you will need someone to drive you home.

How to prepare for the test

Tell your health care provider about:

• Bleeding problems
• Drug allergies
• Medications you are taking
• Whether you are pregnant

You must sign a consent form. Blood tests are sometimes done to test your blood's ability to clot. You will be told not eat or drink anything for the 8 hours before the test.

For infants and children:

The preparation you can provide for this test depends on your child's age and experience. For specific information regarding how you can prepare your child, see the following:

• Infant test or procedure preparation (birth to 1 year)
• Toddler test or procedure preparation (1 to 3 years)
• Preschooler test or procedure preparation (3 to 6 years)
• School age test or procedure preparation (6 to 12 years)
• Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

You will feel a stinging pain from the anesthetic needle and when the anesthetic is injected. The biopsy needle may feel like deep pressure and dull pain. Some people feel this pain in the shoulder.

Why the test is performed

The biopsy helps diagnose many liver diseases. The procedure also helps assess the stage (early, advanced) of liver disease. This is especially important in hepatitis C infection.

The biopsy also helps detect:

• Cancer
• Infections
• The cause of abnormal levels of liver enzymes that have been found in blood tests
• The cause of an unexplained liver enlargement

Normal Values

The liver tissue is normal.

What abnormal results mean

The biopsy may reveal a number of liver diseases, including cirrhosis, hepatitis, or infections such as tuberculosis. It may also indicate cancer.

This test also may be performed for:

• Alcoholic liver disease (fatty liver, hepatitis, or cirrhosis)
• Amebic liver abscess
• Autoimmune hepatitis
• Biliary atresia
• Chronic active hepatitis
• Chronic persistent hepatitis
• Disseminated coccidioidomycosis
• Hemochromatosis
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatocellular carcinoma
• Hodgkin's lymphoma
• Non-alcoholic fatty liver disease
• Non-Hodgkin's lymphoma
• Primary biliary cirrhosis
• Pyogenic liver abscess
• Reye syndrome
• Sclerosing cholangitis
• Wilson's disease

What the risks are

• Collapsed lung
• Complications from the sedation
• Injury to the gallbladder or kidney
• Internal bleeding

References

1. Lomas DJ. The liver. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 35.
2. Liver. Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:section IX.

Review Date: 1/10/2011.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.