Liver biopsy is used to diagnose the cause of liver disease. In jaundiced patients, imaging such as an ultrasound (US) scan and endoscopic retrograde cholangiography should initially be used to exclude an obstructing lesion. It is also used for diagnosis of a spaceoccupying lesion such as a tumour or abscess. Biopsy may be preceded by a CT scan to determine if metastatic disease is present and may be guided by CT or ultrasound.
Prior to the biopsy coagulation studies should be checked and a sample sent to transfusion for group and save serum. Hepatitis B and C surface antigen status should be known. Patients with abnormal clotting should have their liver biopsy postponed until this is corrected. If uncorrectable, biopsy may be undertaken through the hepatic veins, using a transjugular approach.
A biopsy needle is passed percutaneously, and the biopsy taken whilst the patient holds their breath in expiration. Percutaneous aspiration of an abscess is occasionally performed. Complications include haemorrhage, bile leakage and pneumothorax. After the procedure the patient should rest on their right side for 2 hours in bed and should gently mobilise after bed rest for a further 4 hours.