Everything to know about an ultrasound-guided liver biopsy

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Ultrasound-guided liver biopsy is a safe procedure that helps ensure the accurate placing of the biopsy needle tip to sample the appropriate site on the body. A doctor will ask for this test if they suspect liver abnormalities and require confirmation.

During this procedure, a doctor makes a small skin incision below or between the lower ribs. They then insert a slender needle through the opening to collect a sample of liver tissue for examination.

Ultrasound images guide the needle accurately through the liver so that the procedure is safer and complications are minimal.

A person may need a liver biopsy if they have complications that a doctor cannot determine using the individual’s symptoms or a lab test. Someone may need a liver biopsy if they have:

• an enlarged liver
• unusual lab results that may indicate liver disease
• liver tumor
• fatty liver disease
• autoimmune disease
• liver fibrosis
• jaundice
• hepatitis
• alcoholic liver disease

Generally, an ultrasound-guided liver biopsy is a safe procedure when a specialist performs it. However, possible risks that may arise include:

• Bleeding: Even though it is rare to bleed after a liver biopsy, it still happens. Excessive bleeding may require a blood transfusion or surgery.
• Infection: Although rare, bacteria may enter the abdominal cavity or blood, causing an infection.
• Injury to a nearby organ: While it is rare to injure organs or vessels during an ultrasound-guided biopsy, injury can affect organs such as the gallbladder or lungs.

Rare complications that may occur after a liver biopsy include:

• infections leading to sepsis
• pneumothorax, partial or total collapse of a lung
• hemothorax, bleeding inside the lung

A person may also have other risks specific to them. It is beneficial to speak with a doctor about these concerns before the procedure.

Although liver biopsies do not require much preparation, it is best to ask a doctor for the best ways to prepare before the procedure. A doctor may ask someone to:

• complete a physical exam
• provide a complete medical history
• stop taking blood thinners, such as pain relievers, anticoagulants, and certain supplements, if applicable
• have a blood test
• fast at least 8 hours before the procedure
• bring someone with them to drive them home afterward

For an ultrasound-guided liver biopsy, a person can expect the following:

When arriving

Just before a liver biopsy, a nurse or doctor will request the patient’s medical history and take a clinical assessment. A nurse will give them a hospital gown to wear for the procedure. Afterward, the healthcare professional will use a needle to administer a sedative to help the patient relax.

A diagnostic medical sonographer will explain the procedure, while the imaging physician will explain the risks and benefits. After this, the patient will sign a consent form.

During the biopsy

Here is what to expect during an ultrasound-guided liver biopsy.

1. The procedure will take place with the person lying on their back on an examination table, either with their right arm above their head or lying on their left side.
2. Doctors will take ultrasound images of the stomach to enable the precise location of the biopsy area.
3. The doctor will apply a warm gel to the abdomen. This gel allows sound waves from the ultrasound to travel into the stomach easily.
4. They will also place a wand-like handheld device, which people call a transducer, over the area they are examining. Although this part is painless, a person may feel slight discomfort from the device.
5. When the imaging physician finds the biopsy area, they will clean the abdomen and place sterile drapes over the surgical area.
6. The imaging physician will then apply anesthesia to numb the biopsy site.
7. Medical professionals will precisely insert a biopsy needle into the area to collect a tissue sample from the liver.

After a liver biopsy

After the procedure, a healthcare professional will monitor the patient for a while. The operated area may be sore for a few days. A person should only take pain medications that the doctor has prescribed, as aspirin or other painkillers may increase the risk of bleeding.

A pathologist will examine the collected tissue through a microscope to look for signs of any underlying conditions. These results are usually ready within a couple of days.

Doctors often recommend avoiding strenuous activities for at least a week. A person should talk with their doctor to know when they can resume their usual activities.

The amount of pain a person will experience depends on the method the doctor uses to carry out the biopsy. The two types of ultrasound-guided liver biopsy include the subcostal procedure, which is below the rib, and the intercostal procedure, which is between the ribs.

Research has found that although both procedures amounted to the same pain during the procedure, the subcostal route caused less pain 2 and 4 hours after the procedure.

Pain after a liver biopsy usually involves mild discomfort. A doctor may recommend a narcotic pain medication such as acetaminophen with codeine.

An ultrasound-guided liver biopsy helps ensure there is no damage to major blood vessels or organs during the procedure.

Some people experience discomfort following a liver biopsy. While doctors typically recommend over-the-counter pain relief, any discomfort should stop after a few days.

Though complications are rare, they are possible. If a person experiences complications after a biopsy, they should seek immediate medical attention.

An ultrasound-guided liver biopsy is a generally safe and easy way to discover any liver abnormalities. A doctor will typically carry use this procedure to rule out any diseases of the liver.

During an ultrasound biopsy, healthcare professionals will use a slender needle to collect a small sample of liver tissue for examination under a microscope. After a few days, a pathologist will generate a report, and the doctor will discuss the diagnosis and next steps with the person.

Liver biopsies may cause discomfort, but a doctor can recommend pain medications to help. People should contact a healthcare professional if they experience any complications from the procedure.