What is the purpose of a biopsy?

Having a liver biopsy allows your doctors to examine the structure of your liver microscopically. This may give vitally useful information about the cause and severity of your liver problem, and enables them to give you the best advice on your management.

Where will I have my biopsy?

We perform our liver biopsies within our own ward in Groote Schuur Hospital. We have a bright, pleasant and comfortable ward and excellent nursing staff and our patients are very satisfied during their short stay. Our doctors do not perform biopsies in other hospitals: it is far safer to have our patients remain under our direct supervision.

How is the liver biopsy performed?

The liver biopsy is a relatively simple procedure. If you are not already in the hospital, you will be asked to have yourself admitted at approximately eight o'clock on the morning of the biopsy. You should have a light breakfast before the biopsy; having eaten something causes your gallbladder to empty which is helpful. On the morning of your biopsy, a blood sample may be drawn to ensure that your blood clotting is satisfactorily. Thereafter an intravenous drip will be inserted into your arm so that we came give you fluids and injections as necessary.

Immediately before the biopsy, your doctor will inject pethidine into your drip. This is a powerful sedative and analgesic (pain-killer), similar to morphine. This will make you drowsy, though you will not actually lose consciousness. Your doctor will then carefully examine your ribs on the right-hand side to determine the best spot for the biopsy and will clean the skin around this area very carefully. You will then receive an injection of local anaesthetic. This may be a little uncomfortable as it may sting.

Since the liver lies under the lower ribs on your right-hand side, the biopsy is actually performed by inserting a needle between two of your ribs. Once the local anaesthetic has had time to work, your doctor will ask you to co-operate by breathing in and out according to his or her instructions. The biopsy itself is a very quick procedure: a special needle attached to a syringe is quickly advanced through the anaesthetised area and then immediately withdrawn: a tiny piece of liver (as shown in the following photograph) is caught up within the needle and comes out with it. Thereafter a dressing will be placed over the needle site and you will be asked to lie on your right-hand side for several hours so as to apply some pressure over the liver and reduce the chance of bleeding. You will be feeling sleepy after your pethidine injection and will welcome the opportunity to rest. Our nursing staff will however check your pulse and blood pressure at regular intervals to ensure that all remains well.  

How safe is it?

A liver biopsy is an extremely safe procedure. The principal risks are bleeding and of a leakage of bile if the needle should unfortunately penetrate one of the larger bile ducts. both these complications are most uncommon. Even where they do occur, in most instances they settle down by themselves, though patients would be required to stay in hospital one or two extra days for observation and, if necessary, for further treatment. Where more serious, an operation would be necessary to seal the bleeding or the leak: this is however very rare indeed. Doctors attached to our Liver Clinic perform as many as four or five biopsies per week, and collectively we have a vast experience and a minimal rate of complications. 

Will it hurt?

Your doctor will take great care with the correct placing and injection of local anaesthetic as well as with the biopsy itself and the chances are that you will feel no pain. Approximately one patient in five experiences some discomfort during the few seconds required for the biopsy itself , but in general, the biopsy is a considerably less unpleasant experience than having a dental filling! Some patients experience pain or discomfort between the ribs or in the shoulder following the biopsy whereas many have no discomfort at all. If you have any pain, we will give you tablets or even an injection to settle it. We do ask you not to take aspirin or other anti-inflammatory drug, as these may interfere with the ability of your blood to clot. Pracetamol and codeine are however safe.

How long will I stay in hospital?

If you are otherwise in good health, have had an uneventful biopsy without complications and have friends or relatives who can take you home by car, you will be allowed to return home in the late afternoon or early evening of the same day. If our staff are not entirely satisfied with your condition, or if you do not have access to transport, we may recommended that you spend the night with us. You may return to work the next day provided you restrict yourself to light duties, but it is quite reasonable to take a day off work and you will be given a certificate if you require it.