Liver biopsy is a test in which a small piece of liver tissue is removed for microscopic examination. It is the best liver disease test, quantitates the extent of liver damage, and defines treatment. If all other scans like ultrasounds or MRIs and lab tests are worthless, a liver biopsy yields extremely valuable information about the liver.

What is Liver Biopsy?

Liver biopsy is a small procedure for taking a sample of liver tissue to establish histopathological diagnosis. This is tissue scanning for inflammation, fibrosis, tumor, or other pathology. The liver is an important organ for filtering nutrients, detoxifying blood, and protecting against infection. So, the role of the liver when in a healthy state is most important in becoming healthy.

The biopsy generally can be done in a small needle into the liver, usually under imaging guidance. It is to have sufficient tissue so that one could diagnose satisfactorily with minimal damage and minimal discomfort.

Why is a Liver Biopsy Done?

Liver biopsies are prescribed when there is a deviation of the imaging, blood, or liver function test results that needs to be evaluated further. Some of the most common reasons for a liver biopsy are:

  • Diagnosis of Chronic Liver Diseases: Like hepatitis B and C, autoimmune hepatitis, hemochromatosis, Wilson's disease, and fatty liver disease.
  • Measuring Fibrosis and Inflammation: To measure the degree of scarring in the liver (fibrosis) and inflammation. It is used when one is staging liver disease and also when determining whether and how to treat.
  • Monitoring Fibrosis in Efficacious Treatment: It can be used to monitor effective treatment in individuals with established liver disease.
  • Baffling Dysfunction of the Liver: In baffling jaundice, fatigue, or abnormal liver tests.
  • Suspected Liver Cancer or Metastases: Exclusion or diagnosis of liver mass malignancy by biopsy.

Preparation for a Liver Biopsy

Liver biopsy preparation is simple but required for safety and integrity. The following are the highlights:

  • Medical History Interview: Your physician will perform a medical interview, asking among other things, for allergies, medications, and medical illnesses. Bleeding medications are omitted in an attempt to limit bleeding.
  • Blood Tests: These are sometimes arranged ahead of time to check liver and clotting function.
  • Fasting: You may be requested to stop eating and drinking for at least 6–8 hours prior to treatment.
  • Consent: Consent will be obtained from you for signing an agreement form regarding you acknowledging the procedure, complications, and benefits.
  • Transportation: Since the sedation or the anesthetic can be given, you should arrange to have someone take you home from treatment.

Liver Biopsy Procedure

There are many different kinds of liver biopsies, and the one that is done will depend on what your disease is, how risky you are to bleed, and according to overall health. Here is a description of Liver biopsy procedure of the most prevalent ones:

Percutaneous Liver Biopsy

It is the most common type. A needle is placed in the upper right quadrant of the abdomen directly into the liver. Local anesthetic to produce skin numbness and imaging such as ultrasound are used commonly to guide the needle. It takes about 15–30 minutes and it is performed typically on an outpatient basis.

Transjugular Liver Biopsy

It is done in ascites or bleeding disorders patients. A catheter is placed via a neck vein and toward the liver direction. The catheter has a biopsy needle to procure the tissue. It may be done under local anaesthesia and even during in-patient stay.

Laparoscopic Liver Biopsy

It is tiny hole in the abdomen and insertion of a laparoscope (narrow, flexible tube with internal video) into it to look inside the liver and obtain a biopsy. Much more invasive and generally only used in cases where visual examination of the liver also needs to be performed.


What to Expect After the Liver Biopsy

Once the biopsy is complete, you’ll be asked to rest for a few hours under observation. Nurses will monitor your vital signs to ensure there are no Liver biopsy complications like bleeding or infection.

You may experience some pain or discomfort at the biopsy site or in the right shoulder (referred pain from the diaphragm). This is usually mild and resolves within a day. Over-the-counter pain medications may be prescribed.
You may be told to rest and avoid lifting heavy weights and doing hard exercise for 24–48 hours. Every day activity is usually resumed a few days later, depending on how one feels and what the doctor advises.

Interpreting Liver Biopsy Results

The tissue sample taken out is studied under a microscope by a pathologist. The test can detect:

  • Presence and quantity of inflammation
  • Quantity of liver fibrosis (scarring)
  • Deposition of fat, i.e, fatty liver disease
  • Cirrhosis signs
  • Abnormal or cancer cells
Liver biopsy results will typically be available in a week to ten days. Test results enable your doctor to measure the extent of disease in the liver and take appropriate actions. Normal results report lack of liver disease. Abnormal result signifies infections, autoimmune disease, fatty liver, or malignancy.

Diseases Diagnosed with Liver Biopsy

Liver biopsy is diagnosis and follow-up of most liver diseases, such as:

  • Hepatitis B and C
  • Non-Alcoholic Fatty Liver Disease (NAFLD)
  • Alcoholic Liver Disease
  • Autoimmune Hepatitis
  • Hemochromatosis
  • Wilson's Disease
  • Primary Biliary Cholangitis
  • Liver Cancer or Metastatic Tumors
In all the above, Liver biopsy indications gives a definite of liver tissue diagnosis for diagnosis and therapy.

Liver Biopsy vs. Endoscopy

Both are helpful in giving helpful information on belly health but for other reasons. Liver biopsy is used in testing liver tissue, for tumor and fibrosis and inflammation and is clean need for overall diagnosis. Endoscopy is not examining the gastrointestinal tract by means of using a flexible catheter with an internal camera.

It picks up ulcers, varices (one of the classic cirrhosis of the liver presentations) and bleeding of the gastrointestinal tract. Both of these are done together if portal hypertension is suspected or GI and liver symptoms together.

Cost of Liver Biopsy in Pakistan

Liver biopsy in Pakistan can also not be standardized when it comes to cost and is based on the hospital, area, and Types of liver biopsy. On average:

  • A percutaneous liver biopsy will range from PKR 8,000 to PKR 15,000.
  • Transjugular liver biopsy, which is more intricate, ranges from PKR 25,000 and above.
These may include procedure fee, doctor fee, anesthetic, and Histopathology of liver biopsy in some cases. Always ask your health center to provide an approximate fee ahead of time.

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