Liver biopsy

Liver biopsy is no longer mandatory under the S100 criteria for hepatitis C treatment and are performed significantly less often compared to previous years.  However, a liver biopsy is still required under the S100 criteria for hepatitis B treatment and there are occasions when one may be required for people with hepatitis C.  These occasions could include:

• Genotype 1 with high viral load
• Genotype 3 with suspected cirrhosis
• Co-infection with HIV or hepatitis B
• Suspected cirrhosis in longer term infection, regardless of genotype

What is a liver biopsy?

A liver biopsy is the removal of a tiny sliver of the liver using a fine needle.  This is then examined under a microscope for signs of disease.  It is a way to determine the condition of the liver.  Hepatitis C is a diffuse disease (the damage tends to be spread or distributed evenly throughout the liver) making the liver biopsy a very accurate means of assessing damage to the liver.

How is it done?

Informed consent must be given prior to a liver biopsy which is performed as a day case procedure.  Patients are required to fast (not eat or drink) before the procedure.  To guard against excessive bleeding, blood is taken to check platelet levels and clotting profile (preferably within a week of the liver biopsy). 

An ultrasound is usually performed beforehand so that the biopsy spot can be marked.  A local anaesthetic is injected into an area between the ribs on the right hand side.  The patient is asked to breathe in a particular way so that the doctor can locate the liver and its depth.  A small nick is then made in the skin to allow entry of the biopsy needle, which is quite fine – about 1.4mm in diameter.  The needle is inserted and a specimen of liver about 1 centimetre in length is taken.  A dressing is placed over the biopsy wound.            

For people with cirrhosis and/or an increased risk of bleeding, a Transjugular Liver Biopsy may be performed.  After care is similar to the following information. 

After the biopsy

Bed rest, either lying flat or on the right hand side, is required for 4 hours to prevent bleeding.  Pulse, blood pressure and the biopsy dressing are checked regularly.  Close observation is maintained for a further 2 hours, although the patient is allowed to get up and move around, and a light meal is usually provided during this period.  Some people may feel pain in the shoulder (referred pain) or discomfort in the abdominal region.  Medication for pain relief and nausea are provided where necessary. 

As is the case with many day procedures, the patient is not permitted to drive so must be collected and driven home AND must have someone stay with them overnight in case of any complications (see below).

Anyone who has undergone a liver biopsy is instructed to not do any heavy lifting or play contact or collision sports for a period of time following the liver biopsy.  Clinic staff will provide this information at the time of discharge.

Complications of liver biopsy

As with any invasive medical procedure, liver biopsy carries a degree of risk and, in rare cases, complications can occur (most commonly bleeding).  These risks should be discussed with patients prior to obtaining their informed consent to the biopsy.

It is vital that anyone experiencing severe pain, swelling in the abdomen or incision area, faintness or shortness of breath, or bleeding from the biopsy wound contact their doctor or the hospital immediately.

Page last updated: Wednesday 15 September, 2010