Liver biopsy

Alternative names
Biopsy - liver; Percutaneous biopsy


The liver is a pyramid-shaped organ that lies within the upper right side of the abdomen. In a typical liver biopsy, a needle is inserted through the rib cage or abdominal wall and into the liver to obtain a sample for examination.

The procedure can also be performed by inserting a needle into the jugular vein in the neck and passing a catheter through the veins down to the liver to obtain the sample.

How the test is performed

The test is usually done in the hospital. You may be given a sedative or pain medication by injection before the test. If the approach is through the abdominal wall, you will be lying on your back with your right hand under your head. It is important to be as still as possible.

The health care provider will examine the liver and determine the correct spot for the biopsy needle to be inserted. The skin will be cleansed, and a small needle will be used to inject a local anesthetic to numb the area. A small incision is made, and the biopsy needle is inserted. You will then be instructed to hold your breath while the biopsy is taken. This is to reduce the chance of puncturing the lung or tearing the liver.

The needle is inserted and removed quickly. Pressure will be applied to stop bleeding, and a bandage is placed over the insertion site.

If the procedure is performed by the transjugular approach, you be lying on your back on a table. The internal jugular vein in the neck will be located. The skin will be cleansed, and a small needle will be used to inject a local anesthetic to numb the area. A needle is then inserted to pass a catheter that is moved down to the liver. X-ray equipment will be used to check the location of the catheter. A specialized needle is then used through the catheter to obtain the biopsy sample.

How to prepare for the test

Tell your health care provider about:

  • drug allergies you may have  
  • medications you are taking  
  • bleeding problems you may have  
  • whether you are pregnant

You must sign a consent form. Blood tests are sometimes done to test for the ability to clot. You may not have food or fluid 8 hours before the test.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

  • infant test or procedure preparation (birth to 1 year)  
  • toddler test or procedure preparation (1 to 3 years)  
  • preschooler test or procedure preparation (3 to 6 years)  
  • schoolage test or procedure preparation (6 to 12 years)  
  • adolescent test or procedure preparation (12 to 18 years)

How the test will feel
There is a stinging pain with the anesthetic needle and the anesthetic being injected. The biopsy needle may be felt as a deep pressure and dull pain. This pain is sometimes felt in the shoulder.

Why the test is performed

The biopsy helps diagnose a number of liver diseases. The biopsy also helps in the assessment of the stage (early, advanced) of the liver disease. This is especially important in hepatitis C infection.

The biopsy also helps detect:

  • cancer  
  • infections  
  • the cause of an unexplained enlargement of the liver  
  • abnormal liver enzymes that have been detected in blood tests

Normal Values
The liver tissue is normal.

What abnormal results mean
The biopsy may reveal a number of liver diseases such as cirrhosis, hepatitis, or infections such as tuberculosis. It may also indicate cancer.

Additional conditions under which the test may be performed:

  • alcoholic liver disease (hepatitis/cirrhosis)  
  • Amebic liver abscess  
  • autoimmune hepatitis  
  • Biliary atresia  
  • chronic active hepatitis  
  • chronic persistent hepatitis  
  • coccidioidomycosis; disseminated  
  • delta agent (hepatitis D)  
  • hemochromatosis  
  • Hepatitis C  
  • hepatocellular carcinoma  
  • Hodgkin’s lymphoma  
  • non-Hodgkin’s lymphoma  
  • primary biliary cirrhosis  
  • pyogenic liver abscess  
  • Reye’s syndrome  
  • sclerosing cholangitis  
  • Wilson’s disease

What the risks are
The most serious risk is internal bleeding. There is a possibility of a collapsed lung and injury to the gallbladder or the kidney.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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