What is the Liver Biopsy?

Liver biopsy is a medical procedure in which a small sample of liver tissue is removed for direct examination under a microscope. This test is usually used in conjunction with blood tests and clinical assessment, however, liver biopsy provides a much higher level of certainty for clinical decision making in people with liver disease.

What information is obtained?

The most relevant information provided by the liver biopsy can be divided into:

Degree of fibrosis: Chronic liver diseases frequently present a progression from the normal state to marked fibrosis (cirrhosis). The biopsy allows to know in which stage of the disease the patient is, which allows to make decisions regarding treatment.
Degree of inflammation of the liver in chronic hepatitis. This will allow to determine the speed of progression that the disease has.

Liver biopsy provides a much higher level of certainty for clinical decision making in people with liver disease.
Dr. Vicente Carreño

Types of Liver Biopsy

There are two types of biopsy

Percutaneous liver biopsy

Percutaneous liver biopsy: This is the type of liver biopsy most commonly used by doctors. It is done by inserting a small needle into the liver through the skin of the abdomen (in the area below the right rib). Through the needle, a small segment of liver tissue is removed, said segment is worm-shaped. In cases in which the patient has bleeding problems, common in many liver diseases, your doctor will advise a transjugular liver biopsy.

Transjugular hepatic biopsy

This type of biopsy is recommended for people who have a blood clotting problem or a large amount of fluid in the abdomen. In this case, an interventional radiologist makes the intervention. Transjugular liver biopsy is done in four steps:

  1. A small tube will be inserted into the neck of the jugular vein.
  2. Using X-rays, the tube is guided until it reaches the liver.
  3. A small needle is inserted through the tube and into the liver.
  4. The needle makes a small incision in the liver and removes the tissue sample.

Frequently Asked Questions

Answers to questions about this technique

Absolutely. In the percutaneous liver biopsy, a small sharp puncture will be experienced in the area where the needle is injected. In many cases local anesthetic is used to numb the area. In these cases, the only thing the patient will feel is pressure when the biopsy needle is inserted. The area will be numbed in a short period of time.

You may request a mild sedative prior to the biopsy, and a sedative or relaxant medication in an intravenous form during the procedure to facilitate the procedure.

The biopsied area usually causes discomfort for several days, so your doctor can prescribe medication to relieve pain.

In most cases, the blood test will be used to diagnose liver diseases. However, biopsy is essential to know the degree of fibrosis in the liver and inflammation, which will determine the development of the disease in the patient. On occasions when there are significant symptoms of the disease and the analysis does not clearly reveal the liver disease, a biopsy will be definitive and necessary for an accurate diagnosis (as is the case of hidden hepatitis C in blood).

Liver biopsy is not a harmless test. It is usually painful in 30% of cases. In 0.3% liver biopsy causes serious complications, including hemorrhage and biliary peritonitis, which can be fatal, although only in 0.03% of cases.
In conclusion, in the majority of cases, no serious complications are detected, in addition, the biopsy allows to know the presence of other factors associated with the main etiological factor, to determine in a precise way the stage in which the liver lesion is found and the degree of inflammation. The currently available non-invasive tests are not sensitive enough to provide all this data.

The test is performed to determine the anatomopathological bases of liver diseases and their evolution, therefore, it is performed in patients in whom liver disease has been diagnosed. This test allows the doctor to base his diagnosis on objective bases. At present, liver biopsy is considered indicated for: a) determining the cause of liver test abnormalities; b) assess the degree of activity and the stage of chronic hepatitis; c) assess alcoholic liver disease; d) investigate fever of unknown origin; e) the diagnosis of multisystemic infiltrative and granulomatous diseases; f) evaluate cholestatic diseases; g) the diagnosis of neoplasms; h) the evaluation of hepatic lesions by drugs; i) the diagnosis of hereditary metabolic diseases; j) the evaluation of the response to treatments; k) evaluation of the liver after liver transplantation; and l) evaluate jaundice, acute hepatitis and dark cause hepatomegaly.

In the clinic of the Hepatitis Viral Study Foundation, liver biopsies are performed, with total safety and comfort for the patient.

References

Hepatólogo en Madrid Dr Vicente Carreño

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Dr. Vicente Carreño
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