Liver biopsy procedures allow doctors to further evaluate a diagnosis of liver disease.
Types of liver biopsy procedures include:
- Percutaneous liver biopsy. A percutaneous liver biopsy is the most common biopsy procedure used to obtain a liver tissue sample. Your child will likely require sedation or diagnostic and interventional anesthesia for this procedure. Once your child is in a state of conscious sedation or asleep, the interventional radiologist may use ultrasound to determine the best location to access the liver. A long but tiny needle is inserted through the skin by the rib cage and into the liver. The needle collects a tiny tissue sample and is removed. A percutaneous liver biopsy takes about an hour.
- Transjugular liver biopsy. When bleeding problems or fluid buildup in the abdomen make percutaneous liver biopsy unsafe, your child’s interventional radiologist can obtain a tissue sample from the inside by accessing the liver through a neck vein. After your child is asleep under anesthesia, a long intravenous tube with a needle at the end travels through the neck vein into the large inferior vena cava and then into a liver vein. A tissue sample is taken through that internal vein to minimize bleeding. This procedure takes about an hour.
- Open liver biopsy. An open liver biopsy is an option if the bleeding risk is very high or if your child's doctor needs a larger liver sample for testing. While your child is asleep under surgical anesthesia, a surgeon makes a 1- or 2-inch incision in the abdomen. The surgeon then clips off a piece of liver and stitches or burns the edge of the liver to prevent bleeding.
What to Expect
What to Expect
Your child should not take aspirin or ibuprofen for two weeks before the biopsy procedure.
Liver biopsy procedures at Riley at IU Health take place in an operating room or a private exam room depending on the type of tissue sample required. Blood tests may be performed before the biopsy to check clotting levels in your child’s blood and help prevent bleeding during the biopsy. Blood may also be drawn a few hours after the biopsy procedure to make sure too much blood was not lost during the procedure.
If your child will undergo sedation, he or she will be asked not to eat or drink for several hours prior to the procedure to prevent vomiting and choking.
You can support and calm your child by staying with him or her prior to the procedure and before anesthesia is given. For some biopsies, you may be allowed to remain with your child during the entire process.
Percutaneous Liver Biopsy
You can expect the following during a percutaneous liver biopsy:
- Your child will wear a hospital gown.
- The doctor will decide if your child will require sedation and/or anesthesia.
- Once your child is sedated, the doctor may use ultrasound to locate the liver.
- The doctor will mark a spot on your child’s abdomen for needle insertion.
- A local anesthetic may also be used to numb the skin where the needle will be inserted.
- The biopsy site will be sterilized.
- The doctor will make a small nick in the skin above the ribs and will then insert the needle.
- The needle will travel into the liver and a tissue sample will be obtained.
- The needle is then removed.
- This procedure may be performed more than once if multiple samples are needed.
- A bandage will be placed on the puncture site.
- After the procedure, your child will be closely monitored for several hours or even overnight.
- Your child will rest in bed for several hours.
- Your child’s pulse, heart rate, blood pressure and temperature will be checked regularly.
- A blood count may be taken a few hours after the procedure to check for signs of internal bleeding or infection.
- Your child may experience pain at the puncture site.
- After being discharged, your child can begin eating and drinking normally.
- You should monitor your child for any breathing difficulties, dizziness, paleness or excessive pain.
Transjugular Liver Biopsy
Your child will be asleep under general anesthesia during a transjugular liver biopsy. You can expect the following:
- Your child will wear a hospital gown.
- Your child will be asked to lie down on his or her back on an X-ray table.
- Your child’s anesthesiologist will begin sedation.
- Once your child is asleep, an interventional radiologist will apply a numbing medicine to one side of the neck.
- An incision is made in the neck and the jugular vein.
- A long, flexible plastic tube (catheter) is inserted into the vein.
- The tube is threaded through this vein and into the large hepatic vein in the liver.
- A contrast dye may be injected into the tube to allow the interventional radiologist to take X-ray images of the hepatic vein.
- After the hepatic vein is visualized, a biopsy needle is threaded through the tube and into the hepatic vein.
- One or more tissue samples are then taken from the liver.
- The catheter is removed.
- A bandage is placed over the incision in your child’s neck.
- Your child will be taken to a recovery room where he or she will rest for several hours.
- Nurses will monitor your child’s pulse, blood pressure and breathing.
- Your child may feel sore at the incision site.
- Your child can gradually return to normal activities over the course of a week.
Open Liver Biopsy
This surgery requires your child to be asleep under general anesthesia to allow the doctor to obtain a larger tissue sample. Open liver biopsy may be a traditional open surgery (requires a larger incision and does not use a laparoscope), but it is often performed laparoscopically (a minimally invasive procedure that involves a smaller incision and the use of a laparoscope equipped with a tiny camera). You can expect the following:
- Your child will wear a hospital gown.
- Your child will be positioned on his or her back.
- The anesthesiologist will begin sedation.
- Once your child is asleep, the surgeon makes an incision in the abdomen that is 1 or 2 inches long.
- If your child is undergoing a laparoscopic biopsy procedure, a tiny camera will be inserted into the incision to get a better view of the liver.
- Surgical tools are inserted into the incision to remove tissue samples.
- One large or several smaller tissue samples are removed.
- The edges of the biopsy site on the liver are stitched or burned to prevent bleeding.
- The incision site is closed with stiches.
- A bandage is placed over the incision site on the abdomen.
- Your child will be taken to a recovery room where he or she will rest for several hours.
- Nurses will monitor your child’s pulse, blood pressure and breathing.
- Your child will feel sore at the incision site.
- Your child can gradually return to normal activities.