Ultrasound or Computed Tomography PATIENT GUIDE and PREPARATION Liver Biopsy
What is a Liver Biopsy? A Liver Biopsy is a procedure that involves taking a specimen ( a small amount of tissue) from within the liver using a very thin needle. It may be done if you have a previously confirmed mass or history of liver problems. It can be done using either Ultrasound (US) or Computed Tomography (CT) to locate the appropriate area of the liver. The purpose of a Liver Biopsy is to obtain a sample of cells with can be sent to the Laboratory for analysis to determine a diagnosis. How should I get ready for a Liver Biopsy? At the time of referring you for a Liver Biopsy your doctor should go over preparation with you. You will also be contacted by the Diagnostic Imaging booking office with further questions prior to booking the procedure All patients must arrange with their doctor to get the following blood tests done 14 days prior to the procedure date: INR, PT, PTT, and Platelets. All patients on blood thinners must consult their doctor about stopping them before the procedure if possible. 2
Recommended times to stop common blood thinners: Clopidogrel (Plavix), ASA (Aspirin) (7 days) Warfarin (Coumadin) (5 days) Heparin (6 hrs) Enoxaparin (Lovenox), Dalteparin (Fragmin), Dabigatran (Pradax), Rivaroxaban (Xarelto) (24 hrs) Diabetics are not to take their insulin or Metformin the morning of the procedure. Please bring it with you to take after the exam as directed. Do not stop taking any medications without first consulting your doctor. If you have any questions about your medications please ask your doctor. All patients on blood thinners must arrange with their family doctor to have their INR, PT, PTT, and Platelets retested one day before the procedure. Tell your family doctor if you are allergic to freezing or any medications. Make sure to follow all preparation instructions carefully. If you do not follow all instructions the test will have to be rescheduled. Call the day surgery booking clerk the day prior to your test to confirm your appointment time at (902)-749-0231 between 12:30pm and 1:30pm. You must bring someone to the appointment with and have them drive you home after. If you do not bring someone, the procedure may not be done. 3
You should have someone to stay with you for 24 hours after the test in case complications arise. You must have nothing to eat or drink 12 hours before your procedure. When you arrive at the hospital register at Day Surgery. At Day Surgery a nurse will check and record your vitals and ask you some questions, before bringing you to Diagnostic Imaging. What can I Expect for my Liver Biopsy? You will be asked to change into a hospital gown while in Day Surgery. You will be sent to either to the CT or Ultrasound waiting room depending on how the liver biopsy is scheduled to be done. A nurse will be present with you in Diagnostic Imaging during your procedure. Before the procedure starts, the Radiologist (x-ray doctor) will go over the procedure with you and ask you to sign a consent form. This is a good time to ask any questions you may have. You will be lying down for the procedure either on a stretcher (in US) or on the CT table. 4
You will be hooked up to a blood pressure monitor and pulse oximeter throughout the test. You may be given some conscious sedation medication through an I.V. to help relax you during the test and minimize the potential pain. An initial scan will be done (either using CT or US )to localize any area of interest as well as the best way to access it. The radiologist will first clean off your skin with an antiseptic solution then inject local anesthetic (freezing that is similar to what a dentist uses) to numb the skin and the liver. A needle will be inserted though your skin into your liver. A scan will be done again to confirm proper placement of the needle within the liver. Once proper placement is confirmed a specimen will be withdrawn. Given the individual circumstances more than one sample may be taken. The specimen (s) will then be sent directly to the Laboratory for examination and analysis by a pathologist. 5
A scan may be done after the biopsy to check for any complications. The site will be dressed and pressure will be applied. What can I Expect after my Liver Biopsy? You will be taken back to Day Surgery for recovery and observation. You may feel groggy from the sedation (if used), that will pass with time. Even though freezing was used, you may experience some pain at the biopsy site as the freezing wears off. If you begin to experience intense pain, shortness of breath, or bleeding, it is important you tell a nurse immediately. Depending on your recovery you will be discharged from Day Surgery usually about 4 hours after the procedure. It is recommended you avoid any strenuous activity for 1-2 days after the biopsy. What are the risks for my Liver Biopsy? As with any procedure where the skin is punctured, there is a risk of infection. To minimize the chance of an infection your skin is cleaned with an antiseptic solution before the test (to kill potential germs) and all the instruments used will be sterile. 6
Given the skin and liver will be punctured, there is always a risk of bleeding during and after the biopsy. Any bleeding will be monitored closely before you can leave the hospital. How long will my Liver Biopsy take? You need to register 1 hour prior to your appointment at the Day Surgery reception desk. The procedure itself will take approximately 30-60 minutes. The observation and recovery time will take approximately 4 hours after the procedure finishes. NOTES: 7
The technologists are unable to give test results. Your doctor will receive a copy of the pathology report within approximately 1-2 weeks of the procedure. If you have any questions, concerns or if you are unable to keep your appointment, please do not hesitate to call the booking office at 742-2571 or toll free 1-877-742-2571. Diagnostic Imaging Department Yarmouth Regional Hospital 60 Vancouver Street Yarmouth, NS B5A 2P5 Patient Guides available on http://www.swndha.nshealth.ca/pages/guides.htm SWH promotes a smoke free and scent free environment. Prepared by Diagnostic Imaging Department, SWH. Revised April 2014 8