A liver biopsy is a medical procedure in which a small sample of liver tissue is removed and examined under a microscope. It helps doctors diagnose liver diseases, determine the severity of liver damage, and guide treatment decisions.

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Indications (Why it is done?)

Liver biopsy is recommended when:

  1. Diagnosis of liver diseases – hepatitis (viral, autoimmune), fatty liver disease (NAFLD/NASH), alcoholic liver disease.

  2. Assessment of severity – staging fibrosis, cirrhosis.

  3. Unexplained abnormal liver function tests (LFTs).

  4. Detection of tumors – primary liver cancer (HCC) or metastasis.

  5. Monitoring treatment response – e.g., in chronic hepatitis B or C.

  6. Evaluation before liver transplantation.

Contraindications (When it should be avoided?)

  • Uncontrolled bleeding disorders (low platelets, high INR).

  • Severe ascites (fluid in abdomen).

  • Vascular tumors of the liver.

  • Severe anemia.

  • Patient non-cooperation.

Types of Liver Biopsy

  1. Percutaneous Biopsy (most common)

    • A needle is inserted through the skin (usually in right upper abdomen) into the liver.

    • Usually done under ultrasound guidance.

  2. Transjugular Biopsy

    • Needle is passed through a vein in the neck (jugular vein), into hepatic vein, and sample taken.

    • Safer for patients with bleeding risk or ascites.

  3. Laparoscopic Biopsy

    • Done during laparoscopic surgery.

    • Useful when larger or targeted samples are needed.

  4. Fine Needle Aspiration Cytology (FNAC)

    • Thin needle used for cytology rather than histology.

    • Commonly for suspected liver tumors.

Preparation Before Biopsy

  • Detailed history and clinical examination.

  • Blood tests: complete blood count, coagulation profile, liver function tests.

  • Imaging (Ultrasound/CT) to locate lesion and plan biopsy site.

  • Stop anticoagulant or antiplatelet medicines before procedure.

  • Patient fasting for 6–8 hours before procedure.

  • Consent obtained and risks explained.

Procedure (Step by Step – Percutaneous Biopsy Example)

  1. Patient lies on back or left side with right arm above head.

  2. Local anesthesia given at puncture site.

  3. Ultrasound probe used to locate liver and avoid blood vessels.

  4. Special biopsy needle (e.g., Tru-cut or Menghini) inserted quickly into liver.

  5. A small core of liver tissue is obtained.

  6. Needle withdrawn and sample preserved in formalin.

  7. Site compressed with dressing to prevent bleeding.

Duration: Usually 15–30 minutes.

Aftercare & Monitoring

  • Patient lies on right side for 2–4 hours to apply pressure on liver.

  • Vital signs (BP, pulse) monitored for 4–6 hours.

  • Observation for complications like bleeding, pain, hypotension.

  • Usually discharged the same day if stable.

Complications

Though generally safe, complications can occur:

  • Pain at biopsy site (most common).

  • Bleeding / hemorrhage – serious but rare (0.1–0.5%).

  • Injury to nearby organs (gallbladder, lung, kidney).

  • Infection (very rare).

  • Puncture of bile duct → bile leak (rare).

Histopathology (What is examined?)

  • Hepatocytes (liver cells) – their health, fat deposits, necrosis.

  • Inflammation – type and degree.

  • Fibrosis / cirrhosis – staging of liver scarring.

  • Tumor cells – presence and type of malignancy.

Advantages

  • Gold standard for diagnosing and staging liver diseases.

  • Provides detailed structural and cellular information.

  • Guides targeted treatment.

Disadvantages

  • Invasive, with small risk of complications.

  • Pain and discomfort.

  • Sampling error (small tissue may not represent whole liver).

  • Requires expertise in both procedure and pathology.

Alternatives

In some cases, non-invasive tests may be used:

  • FibroScan (Transient elastography) – measures liver stiffness.

  • MRI elastography.

  • Blood-based fibrosis markers (APRI, FIB-4, FibroTest).

However, biopsy is still the gold standard when definitive diagnosis is needed.

Conclusion

A liver biopsy is a vital diagnostic and prognostic tool in hepatology. Although it carries small risks, its benefits in accurately diagnosing liver disease and guiding treatment often outweigh the risks. Newer non-invasive methods are reducing the need for biopsy in some cases, but it remains the gold standard in many situations.

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