The liver is a very large organ in the right upper abdomen. In fact, most of the liver hides behind the ribs in the right lower chest. The liver is remarkable, quietly making many proteins, eliminating waste products, and participating in the general metabolism and nutrition of the body. There are many different problems that can occur in the liver. These include virus infections, tumors, hereditary conditions, and problems with the body's immune system.

Reasons for the Exam The physician, of course, will always take a medical history and perform a physical exam. Certain blood studies, known as liver functions tests (LFT), give an overview of the health of the liver. If persistently abnormal, the physician will then perform additional medical studies to determine the exact cause of the problem. This is particularly important because there are now effective treatments for many chronic liver disorders. Finally, the physician will want to know not only the specific cause of the problem but also how serious it is. The liver biopsy helps to answer these questions.

Preparation
Patient preparation for this procedure is the same as for general abdominal surgery, particularly in regard to the intake of food and liquids prior to the surgery. The physician will advise the patient accordingly.

Procedure

The liver biopsy is usually performed as an outpatient. At times, an ultrasound or echo machine is used to identify the best location to make the biopsy. Usually, the physician can make this determination simply by examination. The patient lies quietly on the back or slightly to the left side. In some instances, the patient will be given some mild sedation at this point. The approach to the liver is usually through the lower right chest between the ribs. The area is carefully cleaned. A local anesthetic agent like Novocain is used to numb the skin and tissue below. A specially designed thin needle is inserted through the skin. At this point, the physician will instruct the patient on how to breathe. The needle is quickly advanced into and out of the liver, taking only 1-2 seconds. A slender core of tissue is thereby obtained which is then processed though the laboratory. The entire procedure from start to finish requires only 15 to 20 minutes.

The patient is kept at rest for several hours following the exam with medical personnel checking the heart rate and blood pressure. At times, there is some discomfort in the chest or shoulder. This is usually transient and medication is available if needed. The patient is then given instructions regarding activity and eating and then discharged home. Activity is usually restricted for a day or so.

Benefits

The benefits of liver biopsy are great in the analysis and diagnoses of liver problems. The additional benefit to the patient is quick recovery with minimal pain or discomfort, compared to open abdomen exploratory surgery.

Side Effects and Risks

In most instances, a liver biopsy is obtained quickly and with no problems. As noted, there is occasionally some temporary discomfort in the right side or shoulder. Internal bleeding can sometimes occur as can a leak of bile from the liver or gallbladder. These problems are usually handled conservatively without the need for surgery.

Summary

A liver biopsy is a simple, rapid method of obtaining a specimen of liver for analysis. This information is of great importance in guiding the physician in his evaluation and treatment. While some complications can occur, they are unusual and the benefits of the exam always outweigh the risk. With this biopsy information, effective and specific therapy can usually be provided to the patient.