Liver biopsy
Formal Definition
Percutaneous, laparoscopic, or transjugular sampling of hepatic tissue for histological analysis; used to stage liver fibrosis, diagnose the etiology of liver disease (autoimmune hepatitis, NASH, hemochromatosis), assess treatment response, and guide management decisions when non-invasive tests are insufficient.
How It's Used on the Ward
"Liver bx" or "biopsying the liver" — the gold standard for staging fibrosis and diagnosing unclear liver disease.
Example
""ALT chronically elevated at 3x ULN, viral hepatitis ruled out, ANA positive with hypergammaglobulinemia: autoimmune hepatitis likely. Liver biopsy ordered to confirm diagnosis and assess degree of inflammation and fibrosis before starting immunosuppression.""
Clinical Context
Pre-procedure: platelets >50K, INR <1.5 (or correct with FFP/vitamin K). Transjugular approach for patients with coagulopathy, ascites, or obesity (lower bleeding risk). Post-procedure monitoring: 4–6 hours in recovery, watch for right shoulder pain (diaphragmatic irritation) and dropping Hgb (hemorrhage). Most feared complication: hemorrhage (1–2%); biliary leak or hemobilia rare. Non-invasive alternatives: FibroScan (transient elastography), FIB-4 score, APRI score — increasingly replacing biopsy for fibrosis staging in chronic hepatitis C. Biopsy remains gold standard for diagnosis when etiology is unclear or for grading/staging inflammatory activity.