Liver Biopsy in Indianapolis, IN
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What is a liver biopsy?
A liver biopsy is a procedure where your GI providers in Indianapolis, IN extract a sample of tissue from your liver. This sample is then analyzed in the lab setting. A liver biopsy might be recommended as a way to gauge how much a disease has progressed (such as liver cirrhosis). A biopsy result can be an extremely useful way to monitor a patient’s health.
A majority of liver biopsies are done through the skin (percutaneously). Most of our Indianapolis, IN patients can be discharged within 2 – 4 hours. If a percutaneous (skin) biopsy can’t be performed, our GI team may recommend another option. It is normal to feel anxious or concerned when a biopsy is ordered. Many people think they have cancer when they need a biopsy or are afraid it will cause extreme harm. The current method for percutaneous liver biopsies has been around since the 1950s and is performed with little risk to the patient. Our team at Indianapolis Gastroenterology and Hepatology does whatever you need in order to make the procedure comfortable and easy. If you are interested in finding out more, request a consultation today.
What are the reasons for requesting a liver biopsy?
Liver biopsies are carried out by radiologists, hepatologists, gastroenterologists, and at times, during surgery. A liver biopsy is only recommended when it is needed for certain treatment choices. They are done for Indianapolis, IN patients who:
- Monitor the liver health of patients who recently received a transplant
- Diagnose an unexplained liver disorder or determine the cause behind abnormal liver function tests (exams that showcase damage to the liver)
- Measure the severity of various kinds of liver ailments, including chronic hepatitis B or C, autoimmune hepatitis, nonalcoholic steatohepatitis (NASH), primary biliary cirrhosis, hemochromatosis, primary sclerosing cholangitis, or Wilson's disease
If you’re experiencing a fever with no known cause, you have an uncommon metabolic disorder, or another rare condition, a liver biopsy might be a good option for you. There are a few situations where a liver biopsy might be unneeded, or even dangerous.
- Has a skin infection at the site used for the biopsy
- Has a low blood count (severe anemia)
- Presents with ascites (excess fluid in the abdomen)
- Is disoriented or will not cooperate for the procedure
- Has problems with blood clotting
What should I do before the liver biopsy?
A blood test will be taken before the procedure to ensure there are no conditions that will prevent your blood from clotting. It’s important that your blood can clot in order to stop the bleeding after a biopsy. Don’t take any medications that elevate your bleeding risk like:
- Aspirin or aspirin-containing compounds Nonsteroidal anti-inflammatory drugs like ibuprofen (e.g., Advil® or Motrin®), Naproxen (e.g., Aleve®) Blood thinners (e.g., Coumadin® or warfarin)
- Specific medications prescribed for patients with heart conditions (such as Reopro®, Persantine®, Ticlid®, and Plavix®)
- Natural supplements (like Ginkgo Biloba or fish oil)
Go over any over-the-counter medications or prescriptions with your GI doctor. This is a safeguard to ensure this procedure can continue without the risk of bleeding.
We will perform an ultrasound of the liver and gallbladder. This is to decide which location is best for your biopsy. The ultrasounds used sound waves. This creates an image of the organs and is a painless procedure. A light breakfast or refraining from eating and drinking altogether after midnight on the day of the procedure may be advised. However, you could be told to include a little bit of fat with your light breakfast (butter, etc) to help the gallbladder empty. Medications may also be administered, to make sure to schedule a responsible adult to come to drive you home after discharge. When you have someone with you, they are also able to keep you company for a few hours after the procedure. While antibiotics are not usually provided before, they can be given in the case of primary sclerosing cholangitis to lower the chance of infection.
For any additional questions, request a consultation with our team at Indianapolis Gastroenterology and Hepatology.
What can I expect on the day of my liver biopsy?
Once you arrive our team will go over all details with you including what medications you’re on and any drug allergies, as well as going over your entire medical profile. Fluids and medications may be injected via IV from one of our nurse staff. It is possible to feel minor discomfort while the line is injected. The GI doctor will go over the biopsy steps with you, and provide you with a consent form to sign. The form will list any alternatives to the procedure, the dangers associated, and why the biopsy is being performed. To help with comfort, a pain reliever or sedative can be provided. However, it is important to note that some providers don’t prefer this because the biopsy will go smoothly when you’re aware and cooperative.
For the biopsy, you will lie on your right side on the exam bed and fold your right arm beneath your head. Our GI physician will have you exhale and tap your finger along the side of your abdomen. Once the best spot is determined, the entry point is noted with a marker. The injection site is sanitized with iodine and alcohol, and clean towels are placed around the entry area. A local anesthetic is used to numb the site. Some Indianapolis, IN patients have reported a burning sensation as this happens. A small cut is then made to allow the biopsy needle to pass into your body.
Several specialists will go over a controlled breathing routine with you before the procedure. It will involve breathing out completely and holding your breath for four counts. This is because when you exhale air from your body the right lung is the smallest at this moment. This allows the liver to move up toward the chest. When this happens, if we inserted the needled during this time, it can minimize the risk will cause damage to other nearby organs. It is important to cooperate and listen closely to the breathing instructions.
The preparation for the biopsy is longer than the actual procedure. The needle will enter and leave quickly, removing a small piece of liver tissue as it comes out. At certain times, automated machines are used to insert the needle in and out. After the needle has been inserted and out of the skin, you can breathe normally. The biopsy site will be small enough to cover with a bandage and you won’t have to worry about any stitches. To recover you should lie on your right side for a few hours and apply pressure to the injection site to reduce bleeding.
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What are the risks associated with liver biopsies?
A liver biopsy is a safe procedure when carried out by one of our GI physicians. Only an estimated 2 – 3 percent of patients in Indianapolis, IN experience complications and hospitalization after the biopsy. The mortality rates are extremely low, happening in just 1:12,000 patients. However, the most widely reported complications can include:
Bleeding: Severe bleeding can happen, but its only been reported in 0.3% of patients. It is generally noted within 3 to 4 hours after the procedure. Any significant bleeding may require a blood transfusion. Severe cases of bleeding might require surgery or angiography.
Low blood pressure: Patients can experience low blood pressure immediately after the procedure. It is usually because of a vasovagal response where the heart rate slows because the blood vessels throughout the body are expanding. Medications can be used to treat this, as well as IV fluids, pain relievers, and monitoring. If your blood pressure doesn’t go back to normal, it may be a sign of bleeding.
Puncture: The needle used might hit an organ close to the liver. In general, this isn’t a serious medical issue for our patients. But a puncture in the gallbladder might result in bile peritonitis.
Bile peritonitis: The liver and its ducts are filled with bile (the fluid that aids in digestion by breaking down fats). Peritonitis happens when the wall of the abdomen is inflamed as a result of a bile leak. Fewer than 1 in 1,000 results in this condition, and it can clear up without intervention. When the leak is a result of a gallbladder injury, the gallbladder may need to be removed.
Discomfort: Discomfort can be present on your right side where the needle went through. This discomfort can last up to 24 hours, while others have reported longer-lasting tenderness. Mild pain killers like acetaminophen (Tylenol®), which is safe for individuals with liver disease as long as less than 2 grams, can be taken in a 24-hour period. Stronger medications can be given for severe cases of pain. If you have more intense, persistent pain, contact our office as it may be a sign of a larger problem.
Response to medication: Some providers will give sedatives or pain relievers during the procedure. You can experience allergic responses, low blood pressure, or breathing problems. Adverse reactions can be treated quickly. It is important to note that few patients experience a reaction to the anesthetic (usually lidocaine).
Infection: Patients with primary sclerosing cholangitis, or other conditions, can end up getting the bile ducts blocked. If it is blocked, bacteria can get into the blood. It is uncommon for the biopsy site to become infected.
What can I do after the biopsy?
After your biopsy, it is important to avoid strenuous activities for a period of 5 to 7 days after. Try not to do any heavy lifting (more than 15 to 20 pounds), and don’t take medication that could thin your blood. Call our GI providers at Indianapolis Gastroenterology and Hepatology in Indianapolis, IN if you experience any of the following symptoms:
- Shortness of breath
- Pain in your chest
- Pain in your abdomen
- Bleeding where the biopsy needle was injected
- Heart flutters (palpitations)
- Severe pain in the right shoulder or at the biopsy site
Monitor and protect your health
In most situations, your biopsy results will be ready within a week of your procedure. You will have another appointment to follow up and go over the results with your GI doctors. If you require a liver biopsy to diagnose or monitor your liver, request an appointment with us at Indianapolis Gastroenterology and Hepatology in Indianapolis, IN.
Everyone is so friendly and very helpful. Dr. Drake explains everything and is so understanding.
All went well with my recent colonoscopy. Dr. Haynes was kind and professional. All my nurses were considerate and helpful.
Great went very smoothly .
Extremely caring and communicative!