Is the exam painful?
Although it is literally exhausted in a second or a little more, given the preparatory phase, liver biopsy lasts an average of 15-20 minutes.
During sampling, the patient may feel a slight pain or a feeling of pressure on the skin.
In any case, thanks to preventive local anesthesia, the examination is generally well tolerated.
After a liver biopsy
At the discretion of the doctor, the subject will then be discharged in the evening or the following day.
During the stay in the clinic (day hospital) the patient may complain of slight pains in the place where the puncture was performed, sometimes radiated to the shoulder.
Their onset, linked to a slight irritation of the pleura and peritoneum (membranes that envelop the lungs and most of the viscera, respectively), can be easily controlled by administering pain medication. Furthermore, once the liver biopsy is completed, a further fasting phase is scheduled for at least six hours.
As a rule, antibiotic coverage is not necessary, while the patient is subjected to constant monitoring of heart rate and blood pressure, to detect early and rare eventual hepatic hemorrhage.
The liver fragment taken by the medical hepatologist is sent to the laboratory to be analyzed under the microscope by another specialist, the anatomist-pathologist. The biopsy result is usually available after one or two weeks.
After discharge, it is preferable to be accompanied home by a family member, avoiding driving. This advice becomes mandatory in the case where the doctor has administered sedative drugs, and in this case applies for about 12 hours from the end of the procedure.
Back home, the patient must absolutely avoid making physical efforts for the first 24 hours. The next night will be spent in absolute rest and - for precautionary purposes - preferably near a hospital facility (no more than 30 minutes away). In the presence of pain the patient will have to agree in advance with the doctor on how to take the most suitable drugs; for example, all painkillers that interfere with the blood clotting process are contraindicated.
Risks and Complications
Despite being an invasive and bloody examination, liver biopsy is a procedure with a high safety margin, which does not involve risks for the patient. The serious complications are indeed quite rare. The most common, certainly not serious because it is easily manageable, is the post-intervention pain, which affects up to 20-25% of patients, localizing themselves on the puncture site (the upper right part of the abdomen) and spreading quite often to the right shoulder . Another frequent complication, which should not cause too much concern, is the drop in blood pressure (10% of patients). The lowering of pressure is usually due to a reaction called vaso-vagal, during which the blood vessels dilate and the heart decreases its frequency. This episode is very similar to what happens during a fainting, so the patient can complain of blurred vision, weakness and a feeling of failure.
Among the most serious complications, which may require surgery and transfusion therapy, we recall the bleeding (one case in 500-1000 biopsies), which may be mild or more rarely (one case in 2000) severe, to the point of requiring hospitalization with embolization and possible transfusion procedures. The risk of mortality associated with liver biopsy is very close to zero (one case per 10000-12000). A further possible complication is the accidental puncture of a nearby viscus (one case in 3000), while in theory there is also a potential risk of dissemination of tumor cells or spread of infectious processes. Transjugular hepatic biopsy is associated with an additional risk represented by adverse reactions to the contrast medium; it also involves the use of X-rays, so it is not recommended for women of childbearing age.
Preparation for surgery
Liver biopsy is performed on an empty stomach, so the patient is explicitly requested not to eat and drink in the six hours preceding the exam. The subject must present himself with pajamas, slippers and all the documentation relating to the previous checks.
Sufficiently in advance, the patient must inform the doctor about habitually taken medicines, as well as about any ongoing allergies or diseases. Therapy with anticoagulants or drugs that interact with sedatives can in fact be temporarily suspended in view of the examination (usually for a week). Among the medicines for which the doctor may request suspension, we mention antidepressants, anticoagulants, antiplatelet agents, drugs for high blood pressure, antibiotics, asthma sufferers, NSAIDs (such as aspirin, ibuprofen and naproxen) and also some food supplements (garlic, ginkgo biloba and fish oil).
Before the liver biopsy, the patient can be subjected to a small blood sample to determine his coagulation capacity, often poor in people with severe liver dysfunctions. To prevent bleeding episodes, if necessary, concentrations of coagulation factors can be administered.
Once received all the information regarding the techniques used and the risks they entail, the subject must sign the so-called informed consent.
Since the patient will not get out of bed for about 4 hours after the end of the liver biopsy, it is wise to go to the toilet before it starts.
