Having a Liver Biopsy under Ultrasound Guidance

  • Reference Number: HEY1104/2019
  • Departments: Radiology

Introduction

This leaflet has been produced to give you general information about having a liver biopsy.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a liver biopsy?

A liver biopsy is a medical test, where a small sample of tissue is removed from your liver with a needle. The sample is then investigated under a microscope.

Why do I need a liver biopsy?

Having a biopsy will help your doctor to make a correct diagnosis so that you can have suitable treatment. Investigations have shown a potential abnormality in your liver but it is not always possible to determine the cause or degree of these abnormalities by looking at scans alone.  The next step to help us make a diagnosis is to examine a sample of liver tissue under the microscope.

Can there be any complications or risks?

There may be some bruising or a small swelling around the biopsy area due to bleeding into the skin.  This should not be painful and will heal.

There is a small risk of internal bleeding after the biopsy.  If you take any anticoagulant (blood-thinning) medication, including aspirin or warfarin, or if you have a bleeding disorder, there may be a greater chance of bleeding from the biopsy site. This is why you will stay in hospital for a few hours after the procedure so that we can monitor you

How do I prepare for the liver biopsy?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination. 

If you are having your biopsy performed as a day patient, you will need to attend a pre-assessment appointment at the hospital 7 – 10 days before your biopsy appointment.

At that time the nurse will discuss any questions you may have and explain what will happen.  You will also have a blood test to make sure that your clotting is normal.  If your clotting test is abnormal there may be an increased risk of bleeding and you will be given appropriate advice.

At the pre-assessment appointment you will need to tell the nurse details of any medication you are taking and you will be advised about when and if you need to stop taking your anticoagulant medication.

For 6 hours before your appointment time please do not eat anything and only drink plain water (not fizzy).

For 2 hours before your appointment please do not have anything at all to eat or drink.

You may take your usual medications other than anticoagulants as discussed.

If you are diabetic and take insulin, this will be discussed at your pre-assessment appointment and advice given.

If you are an inpatient in the hospital you will be advised by the nurse on the ward regarding any preparation, including blood tests you may need, and any medication requirements.

What will happen?

Day Patients will be asked to attend the Radiology Day Unit on the second floor at Hull Royal Infirmary.

Inpatients at either Castle Hill Hospital or Hull Royal Infirmary will be escorted to the Ultrasound department.  A nurse will check your details and ask you to change into a hospital gown.

You will meet the interventional radiologist, the specialist doctor who will perform your procedure.  The doctor will explain exactly what they are going to do and ask you to sign a consent form.  If there is anything you do not understand, or if you need more time to think about it, please tell the healthcare team caring for you.

A small plastic tube called a cannula may be inserted into your arm so that we can give you any drugs that may be required.

The biopsy will take place in an ultrasound room. You will lie on an examination couch, your skin will be cleaned with antiseptic and your tummy will be covered with a sterile towel.  Local anaesthetic will be injected into your skin to numb the area.

The radiologist then uses a special needle to remove a small piece of liver tissue.  The needle is put in through the skin over the liver in the right side of your upper abdomen.  The sample is then sent to the laboratory for microscopic examination. The wound site is cleaned and a dressing put over it.

The biopsy should not be painful, but if you do have any pain, please tell the doctor or nurse and you will be able to have some pain relief.

What happens afterwards?

Inpatients will be escorted back to their ward after the biopsy.

Day patients will be wheeled on the trolley through to the recovery area after the biopsy. As this is a clinical area, we are not able to accommodate someone to stay with you, but if you have any special requirements please discuss this with your nurse at your pre-assessment appointment.

You will need to stay in bed for about 4 hours, either on your side or on your back as instructed.

The nurse will check your blood pressure and pulse, and check on the wound at regular intervals.

You will be offered a drink and something light to eat, but please bring something with you if you have any special dietary requirements.

You will be advised when you can get up and move around.

If you are a day patient, you feel well and all your observations are satisfactory, you will be able to go home the same day.  You will need to arrange for someone to take you home by car or taxi.  It is not advised to travel home on public transport.

Inpatients will be advised about discharge home, depending on other treatment required

What do I need to do after i go home the day of the biopsy?

You should rest for the remainder of the day and stay at home for a minimum of 24 hours.

  • Have someone stay with you overnight.
  • Eat and drink normally
  • Continue with normal medications as prescribed.
  • You will be advised when you may re-start your anticoagulant medication if applicable.
  • If you have any pain you may take over the counter pain relief such as paracetamol.
  • Keep a regular check on the biopsy site.
  • Shower no sooner than 24 hours after the procedure and bath no sooner than 48 hours after the procedure.

When will I get the results of my biopsy?

You will be contacted by your referring doctor to discuss the results of your biopsy and any ongoing treatment that may be required.  This is not dealt with by the Radiology Department. The results may take at least one week to come back.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Radiology Department (01482) 675667.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.