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. The needle goes into the liver to take a sample for examination.

The procedure can also be performed by inserting a needle into the jugular vein. A catheter is then passed through the veins, down to the liver, to take the sample.

The test is usually done in the hospital. You may be given a sedative (a medication to calm you) or pain medication by injection before the test. If the biopsy 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 (cut) 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. Ultrasound is often used to guide the needle.

If the procedure is performed through the jugular vein, you will lie 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.

If you receive sedation for this test, you will need someone to drive you home.

Tell your health care provider about:

• Bleeding problems you may have
• Drug allergies you may have
• Medications you are taking
• Whether you are pregnant

You must sign a consent form. Blood tests are sometimes done to test for your blood's ability to clot. You will be told not eat or drink anything for the 8 hours before the test.

For infants and children:

The preparation you can provide for this test depends on your child's age and experience. For specific information regarding how you can prepare your child, see the following:

• 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)
• School age test or procedure preparation (6 to 12 years)
• Adolescent test or procedure preparation (12 to 18 years)

There is a stinging pain from the anesthetic needle and when the anesthetic is injected. The biopsy needle may be felt as a deep pressure and dull pain. This pain is sometimes felt in the shoulder.

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

In addition, the biopsy helps detect:

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

The liver tissue is normal.

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
• Disseminated coccidioidomycosis;
• Hemochromatosis
• Hepatitis C
• Hepatitis D
• Hepatocellular carcinoma
• Hodgkin's lymphoma
• Non-alcoholic fatty liver disease
• Non-Hodgkin's lymphoma
• Primary biliary cirrhosis
• Pyogenic liver abscess
• Reye syndrome
• Sclerosing cholangitis
• Wilson's disease

The most serious risk is internal bleeding. There is a possibility of a collapsed lung and injury to the gallbladder or the kidney. If you also receive sedation for this test, complications from the sedation may also happen.