Liver biopsy

• You must be sober at least 6 hours before the exam. This means that you should not eat, drink or smoke 6 hours before the liver biopsy.
• If necessary, another blood sample will be taken in the room to check the clotting of the blood.
• Use the toilet again before the study.
• A patient apron will be ready in your room, which you can wear.
• Jewels must be removed.

To report before the start of the research:

• Any allergies
• Taking blood thinning medications, e.g. cardioaspirin, plavix, marcoumar, clopidogrel, ticlid, xarelto, pradaxa, eliquis, brilique, marevan, sintrom, etc. These may need to be stopped before the biopsy to reduce the risk of bleeding during or after the biopsy. Your doctor will tell you how far in advance you should stop taking this medication.
• Taking anti-inflammatories
• If you normally take medication in the morning, ask your doctor prior to admission whether this is allowed on the day of the exam.
• If you have diabetes (diabetes), it can be discussed whether to adjust the insulin dose on the day of admission.

Liver biopsy via skin prick

• Before the examination, you lie on your back with your right arm behind your head.
• First, the doctor determines the appropriate location for the biopsy to be taken by means of an ultrasound machine.
• The puncture site is marked and disinfected. This may feel cold for a while.
• The skin is anesthetized locally, which can be equally painful.
• The doctor makes a small incision after the local anaesthetic has taken effect.
• Along the cut, the biopsy needle is inserted to the liver and a piece of liver tissue is removed.
• The needle is removed.
• The sample of liver tissue is collected in a beaker and sent to the laboratory for further research.
• Sometimes a 2nd or 3rd time is pricked.
• The puncture site is covered.

Liver biopsy via the veins

• A few stickers are applied to the wrists and chest to monitor the heart rhythm.
• You are lying on your back and the doctor will ask you to look to the left so that the neck is easily accessible.
• The skin at the neck is disinfected and anesthetized. The injection required for the anaesthetic may be painful. After that, the examination is painless.
• The jugular vein is punctured with a needle. A sheath (plastic, hard and hollow tube) is placed in the vein. Through this sheath, a catheter is inserted. It is spread to the liver under the guidance of contrast agent and X-rays (RX-rays). A needle is inserted over this first catheter. The doctor will use this needle to take a sample of liver tissue.
• The needle is removed.
• The sample of liver tissue is collected in a beaker and sent to the laboratory for further research.
• Finally, the doctor places a bandage at the level of the neck.
• Sometimes, during the transjugular liver biopsy, pressures are also measured at the level of the veins of the liver.

Liver biopsy via skin prick

Immediately after the investigation

• You should lie on the right side for at least 2 hours to exert some extra pressure on the puncture site and thus reduce the risk of bleeding.
• After that, there is another 2 hours of bed rest (except for using the toilet or, if necessary, you will have to use the bedpan or urinal).
• You can eat again 3 hours after the examination.
• The nurse will take your blood pressure and pulse on a regular basis.
• Sometimes an overnight stay is scheduled after a liver biopsy.
• After the liver biopsy, you may feel pain in the upper abdomen or right shoulder, sometimes increasing when taking a deep breath. It is best to report this to the nurse.

The following days

• Avoid lifting heavy loads for the first few days.
• Do not take a bath in the first 4 days because of the small incision that was made. Showering is no problem.

Liver biopsy via the veins

• To prevent bleeding from the puncture site, stay in a semi-sitting position for a maximum of 4 hours. Afterwards, you can get out of bed quietly.
• The nurse will take your blood pressure and pulse on a regular basis.
• The bandage is checked for any signs of bleeding.

• The risk of bleeding is less than 1 in 1000
• The puncture may cause blood or bile loss in the abdomen
• In very rare cases, the puncture hole in the liver must be stitched closed via a viewing operation.