A liver biopsy provides essential information on the liver's structure, degree of inflammation, fibrosis, or other pathology, aiding diagnosis and guiding management.
Performed under radiologic guidance in most cases to enhance accuracy and reduce risks.
Patient cooperation (especially breath-holding) is essential for a safe percutaneous biopsy.
⚠️ Avoid biopsy of surgically resectable malignancies due to the risk of tumour seeding and bleeding.

🎯 Indications for Liver Biopsy

Diagnosis & Staging: Identifies cause of liver disease and assesses fibrosis.
Persistently Abnormal LFTs: When no clear cause is found.
Chronic Liver Disease: Hepatitis, autoimmune hepatitis, NASH, PBC, PSC.
Drug-Induced Liver Injury (DILI): Assessment of medication-related hepatotoxicity.
Suspected Liver Tumours: Confirms diagnosis when imaging is inconclusive.
Inherited Disorders: e.g., haemochromatosis, Wilson’s disease.
Transplant Work-Up: Fibrosis staging and transplant suitability.

⚠️ Risks of Liver Biopsy

Bleeding: 0.6–1% of cases; significant bleeding ~3/1000.
Bile Peritonitis: Rare (1/1000).
Pain: Most common complication; usually mild.
Infection: Rare, but potentially serious.
Injury to Nearby Organs: e.g., lung or kidney puncture.

🧪 Pre-Procedure Requirements

Bloods: FBC, PT, PTT; correct coagulopathy with FFP/Vit K.
Imaging: Pre-procedure ultrasound to assess anatomy/ascites.
Consent: Explain risks, benefits, and alternatives.

🔬 Types of Liver Biopsy

Type	Description	Indications
Percutaneous	Needle through right intercostal space, usually with US guidance.	Standard approach if no ascites or coagulopathy.
Ultrasound-Guided	Real-time US improves accuracy, esp. in obesity or difficult anatomy.	Preferred in atypical anatomy or obesity.
Transjugular	Catheter via jugular vein into hepatic veins; avoids liver capsule puncture.	✅ Coagulopathy, ✅ ascites, ✅ portal pressure measurement.

🚫 Contraindications

Absolute: Uncooperative patient, uncorrectable coagulopathy, severe ascites, extrahepatic obstruction.
Relative: Obesity, hemangioma, previous surgery, local infection.

🩺 Post-Procedure Care

Monitor 2–4 hours (vitals, pain, signs of bleeding).
Rest 24–48 hrs; avoid heavy activity.
Look for ⚠️ right shoulder pain (may indicate bleeding).
Red flags to warn patient: abdominal pain, dizziness, breathlessness.

🔍 Common Findings

Fibrosis/Cirrhosis: Grading severity.
Steatosis: NASH, alcoholic liver disease.
Hepatitis: Viral, autoimmune, drug-related.
Granulomas: TB, sarcoidosis, PBC.
Tumours: Distinguish benign vs malignant.

📊 Interpretation

Histopathology: Inflammation, necrosis, fibrosis, architecture.
Scoring Systems: METAVIR, Ishak scores quantify fibrosis.

🕑 Results usually take a few days. Ensure clear follow-up for results and management planning with the clinical team.

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Liver Biopsy

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