Liver biopsy

What is a liver biopsy?
Liver biopsy is the biopsy (removal of a small sample of tissue) from the liver.  It is a medical test that is done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment. It is a routine procedure, which is done as a day case.

Who will be doing the percutaneous biopsy?
A specially trained doctor called a Radiologist.  Radiologists have special expertise in using x-ray and scanning equipment, and also in interpreting the images produced.  They need to look at these images while carrying out the biopsy.

Are you taking any medicines?We need to know all medication that you are taking, including anti-platelet drugs and anticoagulants.  These are medicines that affect the way your blood clots.  Listed below are some drugs that the doctor will need to be informed about if you have been prescribed them:

Warfarin, Asprin, Enoxaparin, Dalteparin, Tinzaparin, Bemiparin, Fondaparinux, Danaparoid, Apixaban, Coumarins, Acenocoumarol, Phenindione, Lepiridin, Bivalirudin, Argatroban, Dabigatran, Rivaroxaban, Clopidogrel, Dipyridamole, GPllb/lla inhibitors, Abciximab, Eptifibatide, Tirofiban and Plasugrel.

We would also need to know if you have a hereditary bleeding abnormality or abnormal bleeding history after minor procedures such as dental extraction and further tests to assess your blood may be needed.

Day before liver biopsy?

1. You will be asked to attend for a blood test. This blood test will check how well your blood clots. Normal blood clotting is important to prevent bleeding after the biopsy.
2. Please contact Velindre on Tel: 02920615888 and ask for the bed manager Pager 264 who will tell you which ward has allocated a bed for you.

Day of procedure:

Can I eat and drink before the biopsy?
No – you must not eat or drink for up to four hours before the procedure.

Where to go on arrival at Velindre
You will need to report to the ward on your appointment letter. A nurse will have been allocated to looking after you. He/she will check your temperature, pulse, respiration rate, blood pressure, and oxygen saturations (a probe will be placed on your finger and this will measure the oxygen levels in your blood).  You will be given a gown to wear and will be asked to empty your bladder before you go to x-ray where the procedure will carried out.

The procedure:

The person performing the procedure will go through the process with you and explain the potential adverse effects. You will need to sign a consent form.

Your skin will be cleansed prior to the biopsy with an antiseptic fluid. 

A local anaesthetic is injected into a small area of skin and tissues.  This stings a little at first.  Once the area is numb a needle is pushed through the anaesthetised skin into the liver to aspirate a sample of the liver tissue.  The needle is then taken out and a dressing is put over the small wound.

After the procedure you will return to ward: 

You will need to remain on bed rest for four hours.
The nurse looking after you will monitor your temperature, pulse, respiration rate, blood pressure, and oxygen saturations. The nurse will also check your wound site regularly. Bleeding can sometimes happen, as can a leak of bile from the liver or gallbladder.

Do I need to take special care when I go home?

• •    Someone should take you home as driving is not advised in first 24 hours.

Rest for 24hours after the biopsy

• The biopsy site may feel uncomfortable for a day or two after the biopsy. You may wish to take painkillers for this in normal doses of up to two paracetamol tablets every six hours. 
• Avoid any heavy lifting or strenuous exercise for at least 48 hours. 
• Contact sports should be avoided for at least one week; this is to allow your liver to heal. 
• Please make sure that the dressing over your biopsy site remains in place for 24 hours, to prevent any infection. After the 24 hours you can bathe as normal, and change your dressing with the spare dressing provided. 
• Avoid Aspirin or Ibuprofen for the first week after the procedure. These medicines decrease blood clotting which is crucial for healing.

Contact your GP:

• If you have pain at the biopsy site for longer than 4-5days and painkillers do not help. 
• Fever – raised temperature of more than 38.C
• Feeling faint or dizzy, especially on standing

If you develop have any of the symptoms below: 

• Bleeding from biopsy 
• Severe pain around the site of the biopsy or elsewhere in the chest or abdomen. 
• Swelling or bloating in your abdomen

You should go directly to your local Accident and Emergency Department immediately. As Velindre Cancer Centre does not have an emergency department 

Very rarely these complications may cause you to need surgery, this may be indicated if bleeding from the biopsy site is confirmed - this occurs in less than 2-3% of patients.

Take this information with you and give it to the receiving doctor in the accident and emergency department

Discharging nurse: ....................................................

Date of procedure: ....................................................

To: Accident and Emergency Department

This patient is experiencing symptoms after a liver biopsy.  Please contact:

SpR-on-call at Velindre for details on patient’s current treatment plan