Liver Biopsy is a procedure in which a tiny piece of a tissue of the liver is taken using a biopsy needle. It is a safe procedure and is rarely dangerous in the hands of experienced doctors. There are reasons for liver biopsy as outlined below.

Liver Biopsy Procedure

1. First check the patients coagulation status using prothrombin time and platelets to prevent profuse bleeding.
2. Group and cross match the patients blood
3. The patient is then asked to lie on the back near the edge of the examination table or couch
4. The liver margins are delineated using percussion: this helps to know the site to carry out the liver biopsy procedure. Instead of percussion, an ultrasound scan can be used to confirm the liver margins and also the position of the gall bladder.
5. A Local anesthetic agent (such as 5ml of 1% lidocaine) is the injected at the point of maximum dullness of the liver (this is the liver biopsy site); it is located in the mid-axillary line through the intercostal space during expiration. The local anesthetic agent is injected down to the liver capsule.
6. A tiny cut is made in the skin with a scalpel blade
7. A special Liver Biopsy needle named as Menghini needle or Trucut biopsy needle or Surecut biopsy needle is then used to obtain a tissue of the liver whilst the patient holds his breath in expiration.
8. The liver tissue cut out during the procedure is laid on a filter paper and placed in 10% formalin for preservation before being taken to the histopathology laboratory for histology. If a culture of the liver biopsy is required it should be placed in a sterile histology pot.
9. After carrying out the liver biopsy procedure, the patient is observed to ensure he or she is stable for at least 6 hours before going home. This monitoring is done by taking the pulse rate and blood pressure measurements regularly.

The liver biopsy procedure should always be carried out by skilled and experienced doctor (especially by a gastroenterologist). It is a sterile procedure and you should always ensure that consent is taken.

Menghini Needle: One of the needles used for liver biopsy. There are other types of Liver biopsy needles such as the commonly used Tru Cut needle

Liver Biopsy Needles Names and Types

1. Menghini Liver biopsy Needle
2. Klatskin Liver biopsy Needle
3. Vim Silverman Liver biopsy Needle
4. Tru Cut Liver biopsy Needle (this is the commonly used needle)
5. Spring loaded biopsy needle with triggering mechanism

Liver Biopsy Uses

1. To differentiate diffused or localized liver diseases
2. For staging of secondary liver tumors such as lymphoma
3. Grading of liver diseases
4. Monitoring of liver disease progression or response to treatment

Materials or Items used in Liver Biopsy Procedure

Liver Biopsy Indications (Reasons for Liver Biopsy)

1. Unexplained hepatomegaly
2. Some cases of jaundice
3. Persistently abnormal liver biochemistry following Liver function test
4. Occasionally in acute hepatitis B or C
5. Chronic hepatitis C or B
6. Liver Cirrhosis
7. Drug induced liver disease ( drug related liver disease)
8. Infiltrations
9. Tumors of the liver: primary liver tumors or secondary metastasis
10. Infections such as tuberculosis
11. Storage disease (e.g. glycogen storage)
12. Pyrexia of unknown origin (fever of Unknown Origin)

Liver Biopsy Contraindications

1. Uncooperative patient
2. Prolonged Prothrombin time (by more than 3 seconds)
3. Platelets < 80 10⁹ /L: because it may cause profuse bleeding
4. Ascites (abdominal swelling)
5. Extrahepatic cholestasis

Liver Biopsy stained with Hematoxylin and Eosin (H & E) in which severity of Liver Fibrosis cannot be determined.

Conditions for safe Liver Biopsy Procedure

1. Cooperative patient
2. Prothrombin time less than 4 seconds
3. Platelet count more than 100 X 10⁹ cells/L
4. Exclusion of localized skin infection, severe anemia, bile duct obstruction, advanced chronic obstructive pulmonary disease (COPD) and marked ascites

Liver Biopsy Complications (Side effects)

1. Intraperitoneal Bleeding (Hemorrhage into the peritoneum)
2. Hemothorax (bleeding into the pleura of the lungs) causing pleurisy (sharp chest pain)
3. Abdominal pain
4. Shoulder pain
5. Infections (transient septicemia)
6. Hemobilia (bleeding into the biliary tree): Haemobilia causes biliary colic (pain), jaundice and melena (dark colored stool) within 3 days of carrying out a liver biopsy procedure.
7. Biliary peritonitis
8. Misdiagnosis: except in diffused lesions, carrying out a liver biopsy in a case of localized disease of the liver may give a false negative result except under ultrasound scan or CT scan guidance.

Most complications of liver biopsy procedure occur within 24 hours (usually within 2 hours after the procedure).

Liver Biopsy in the presence Bleeding Abnormalities

Liver biopsy can be carried out in a patient with bleeding problems (defective hemostasis) under the following conditions:

1. Following a correction of low platelet count by use of fresh frozen plasma and platelet transfusion
2. Obtaining liver biopsy through the Transjugular route or percutaneously under ultrasound control and plugging of the biopsy needle track with a procoagulant.

Liver Biopsy Risks and Mortality rate

When the liver biopsy procedure is carried out by an experienced doctor, the mortality rate is usually less than 0.02% (that is, less than 2 out of 10,000 may die following this procedure).