Advice after your nerve block for surgery
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Introduction
A liver biopsy is a way of taking a tiny sample of liver from your body, using a special needle passed through the skin. This allows doctors to look at the sample under a microscope for signs of damage.
Why do I need a biopsy?
Your doctor has decided that a liver biopsy is needed to look for signs of liver damage. This may be to make a diagnosis when a liver problem is difficult to diagnose with blood tests and diagnostic scans. Alternatively, a liver biopsy can help to assess the degree of damage from a known liver condition. This can help to guide treatment.
Are there any risks?
Ultrasound guided liver biopsy is generally a very safe procedure but, as with any medical procedure, there are some risks and complications that can arise. The risk of having excessive bleeding from the biopsy site is between 1 in 200 and 1 in 1,000. If bleeding occurs, a blood transfusion may be needed. To stop the bleeding, the patient may have an X-ray guided procedure called embolisation in which the blood vessel causing the problem is sealed off. In some cases, surgery may be needed stop the bleeding.
Other risks are much rarer and include puncture of other internal organs or infection. The risk of death as a consequence of a liver biopsy is less than 1 in 1000.
Unfortunately, some biopsies fail to give an answer. This may be because, despite taking every possible care, the piece of tissue which has actually been obtained is normal tissue rather than abnormal. Alternatively, although abnormal tissue has been obtained, it may not be enough for the pathologist (an expert in making diagnoses from tissue samples) to make a definite diagnosis.
The radiologist performing the biopsy will discuss these risks with you and answer any questions you may have.
What do I need to do to prepare for the procedure?
You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy. Your doctor or clinical nurse specialist will tell you about this and how to arrange it.
Please continue taking any prescribed medication as normal. Please however inform the radiology department at least one week before your procedure if you are taking any blood thinning medication such as: warfarin, heparin, dalteparin, clopidogrel, edoxoban, rivaroxaban, dabigatran or apixaban. You can ring the interventional radiology department to discuss these medications:
Frimley Park Hospital:
Wexham Park Hospital:
You should not eat for 4 hours before the procedure, although you can usually still drink clear fluids such as water. If you are a diabetic, your blood sugar levels will need to be monitored to ensure they remain within stable limits.
An ultrasound guided liver biopsy is normally performed as a day case procedure. When you arrive in the department, you will be informed of the approximate time of your procedure. However, this may change due to unforeseen circumstances. Please bring an overnight bag with you in case you need to stay the night and do bring any books, newspapers or media players that you might want. You should have someone available to take you home at the end of the afternoon and stay with you on the night after the procedure.
What happens before the procedure?
The procedure will take place in the Interventional Radiology Department. You will be welcomed by the radiology staff:
- The Radiologist is a doctor specially trained to interpret X-rays and scans and to perform image-guided procedures;
- Radiology Nurses work with the radiologists and care for the patient during interventional procedures;
- Radiology Department Assistants (RDAs) are healthcare professionals trained to assist the radiologist in preparing and caring for patients undergoing scans and image-guided procedures.
An RDA or nurse will check your details. Please let them know if you are allergic to any medications or skin-cleaning preparations used for the procedure. You will be given a hospital gown to wear.
The radiologist will explain the procedure, answering any questions you or your family may have. When all your questions have been answered you will be asked to sign a consent form.
What happens during the procedure?
You will be taken into the ultrasound room and asked to lie on your back or left side with your right arm above your head. An ultrasound scan of the liver will first be performed to select the best site for the inserting the biopsy needle. The skin over the liver will be cleaned with antiseptic fluid and covered with a sterile drape (towel). The radiologist will give you an injection of local anaesthetic to numb the area. This may cause some stinging, but it will only last a short time. The biopsy needle will be passed through the skin into the liver under ultrasound guidance.
You may be asked to hold your breath and keep still while the biopsies are taken. It may be necessary to perform 2-3 passes of the biopsy needle in order to obtain a sufficient tissue sample. You may feel some minor discomfort as the biopsy is taken. Every patient is different, and it is not always easy to predict how long the biopsy will take; however, expect to be in the radiology department for about 30 minutes.
Transjugular liver biopsy
In some patients, it is not possible to carry out the procedure in the way described above, particularly if there are concerns about abnormal blood clotting or if a patient has developed ascites (fluid in the abdominal cavity). A transjugular liver biopsy is an alternative method — it is carried using X-ray guidance. A very thin catheter (hollow tube) is inserted into a vein in the patient's neck or groin. A contrast dye is then injected into the tube and a series of images taken. The dye enables the specialist to see the hepatic vein. A biopsy needle is then threaded through the tube and one or more liver samples are taken. The catheter is then carefully removed, and the incision is covered with a bandage.
What happens when the procedure is finished?
You will be taken back to a ward, where you will need to rest in bed for 4- 6 hours. Initially you may be asked to lie on your right side to put pressure on the biopsy site and reduce any chance of bleeding. You will have your pulse and blood pressure checked to ensure there have been no complications. About 1 in 5 patients will experience some pain from having a liver biopsy.
This may either be felt over the liver (right upper abdomen) or in the right shoulder. Simple pain-relieving tablets are usually adequate to make things comfortable. It is very unusual for the pain to be severe enough to stop them from going home on the same day. Some soreness may persist for up to a week. You can eat and drink normally unless instructed otherwise by your doctor.
Assuming you are feeling well, you will be discharged the same day and advised to rest. You should not drive home after the procedure. Please ensure you have arranged transport home prior to the biopsy and bring the contact details with you. You should avoid strenuous activity, operating heavy machinery or lifting heavy objects for two days following the biopsy but most patients are fully recovered after this time. If you have any concerns following your procedure, you can contact the interventional radiology department on the following numbers:
Frimley Park Hospital:
Wexham Park Hospital:
You should seek urgent medical advice (call 111 or 999) if you develop any of the following symptoms following your procedure:
- Chest pain
- Bleeding from the biopsy site
- Fever (temperature greater than 100.4 deg F or 38 deg C)
- Severe pain at the biopsy site or shoulder
- Shortness of breath
- Blood in your stool or black, tarry stool
How will I get my results?
The biopsy specimens will be sent for examination. Typically, it can take at least three weeks for the biopsy to be processed in the pathology laboratory and for a report to be sent to the doctor who arranged the procedure. Once the results are available, your hepatology consultant will write to you with the results or bring you back to clinic to discuss further.
Contact us
If you have any queries relating to this information, please contact the Hepatology (liver) service.
About this information
Service:
Hepatology (liver)
Reference:
H/066
Approval date:
1 July 2025
Review date:
1 July 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.