What is a liver biopsy?

What is a liver biopsy?

A liver biopsy is a procedure which in children is usually carried out under general anaesthetic (you will be asleep). A biopsy needle is used to remove a very small piece of tissue from the liver. This is sent to the laboratories and looked at under a microscope.

Why does my child need a liver biopsy?

Your doctor will have discussed with you the reasons but they usually include:

• abnormal blood results
• jaundice (yellow skin)
• suspected liver disease
• sometimes needed to make a diagnosis of another condition

You will not be able to get the results of the biopsy on the day of your procedure. When you are discharged from hospital, you will be sent an outpatient appointment where the doctor can discuss the results with you.

What happens before the biopsy?

Before you have the procedure, the doctor will ask you to have a blood test to make sure that you are well enough for the test.

When the doctor thinks that you need a liver biopsy, they will ask for an adult to sign a consent form to make you or your child aware of the possible complications and the reasons why we are doing the test.

What will happen on the day of the procedure?

It is very important that on the day of your procedure you make contact with the ward you have be asked to report to, to make sure there is a bed for you or your child.

Before the biopsy

When you arrive on the ward, a nurse will admit you and record your temperature, heart rate and how quickly you are breathing. A doctor will then come and make sure you are medically fit. It is important that you child have a cannula. These are usually placed on the back of your hand or in the crease of the elbow. The nurse looking after you can apply some cream to numb these areas if you find this uncomfortable. The anaesthetist, the doctor who will help you go to sleep for the procedure, will ask you some important questions on the ward.

Before going to theatre, you or your child will have an ultrasound scan of the liver. This will take place in the X-ray department. For this procedure you will have to be have nothing to eat or drink (nil by mouth) for at least 4 hours before, so check with the nursing staff on the ward before having anything to eat or drink.

In theatre

The liver biopsy takes place in theatre and will be performed by the radiologists under ultrasound guidance. The theatre list usually starts at 1.30pm. For children under the age of 1, parents will not be able to accompany their child to theatre unless the anaesthetist has approved this. 1 parent is allowed into the anaesthetic room and the nurse looking after you will also be there.

Recovering

When the procedure is complete, you will go into recovery to come around from the anaesthetic. The nurses in recovery will contact the ward to say that you are in recovery. It maybe a while until they phone again to ask you to come to recovery as you may still be quite sleepy. When the nurse in recovery is happy that you are stable, they will escort you back to the ward where the nurse will monitor your blood pressure and heart rate closely. The nurse will also check the biopsy site dressing.

What happens during the procedure?

Once you are asleep a very small cut (incision) is made between the ribs and a special biopsy needle is used to take a very small sample of liver which is sent to the laboratory to be looked at under the microscope. Local anaesthetic will usually have been used round about the incision site to reduce the pain afterwards. Steristrips (paper stitches) and a small dressing will be placed over the biopsy site. These paper stitches will gradually come off in the bath and can be removed by your or parent or carer after about 5 days.

Are there any complications associated with this procedure?

When you attended for your outpatient appointment, the doctor will have explained in detail what could potentially happen. These include:

• bleeding – by doing regular blood pressure checks, any bleeding will be detected quickly
• pneumothorax – where there is an ‘air leak’
• infection
• perforation of the bowel
• pain – from the biopsy site

These complications are rare but all procedures carry a risk and this will have been weighed up against the benefits of the information you and your doctors will gain from the biopsy.