Liver biopsy

[Liverpatient]

Hi folks, I've been asked to undergo a liver biopsy soon by my doctor. As I've asked before in this community, I'm quite afraid of this scary procedure. I've read about it and it sounds there are a number of potential issues of complications such as internal bleeding, infection, lungs and intersine that could be punctured, etc. I feel these risks are probably not worth it especially when my FibroScan and ultrasound tests have yet revealed my liver is quite healthy despite my chronic hbv. What advice could you give, should I risk the biopsy, what are your experiences? Thanks in advance for your replies.

[ArcturusAP]

Is it correct that most liver biopsy is altra sound guided these days?

Would this create less risk by being able to see where the needle is penitrating?

[Liverpatient]

I think the risk is not only the needle piercing other organs/body parts unintended; but also internal bleeding and infection as the result of the liver sampling.

[Bm2016]

i have my liver biopsy done two times, approximate 5 years apart, need fasting, the first time, more than a decade ago, it was performed by my GI doctor, without guided ultrasound equipment, more like a spring loaded syringe gun, fire into body and retrieve two small sampling meats from liver, one from the middle of the body, right below where the left and right rib cage meet, one on the right side below the rib cage, and i slept on my right side still for 4 hours for observation to make sure no internal bleeding.  the 2nd time was quick, done using guided ultrasound and long needle, took two samples, but one of the sample was not "successful", so they poke again.  now i have 5 permanent red small dots in my belly as souvenirs, and they only kept me on bed for 30 minutes, and wait for the numbing drug to expire and fully cohere, and they fed me with crackers and juice, then go home.  both time required designated driver.
i think now the technique has greatly improved.

[Liverpatient]

Hi, thanks for sharing your history: did you feel any pain, if so how painful and for how long? Some report of some pain, others of big pain that goes for days if not weeks, and others report of no pain at all. How could all these discrepancies happen?
This is how I imagine the biopsy: because they numb you on the area of needle entry, there is no pain outside, but since the needle is going all the way to the liver and other deeper abdomen parts which are not numbed, then there should be some pain in there.

[cure4life]

I don't want to scare you.  But my biopsy was really painful.  They did two passes. I felt pain in my heart. Thought I was having some heart problems from the pain.  Everyone always says it doesn't hurt. I guess I am the exception. I think everyone is different though. I just wanted you too know because everyone told me it wouldn't hurt and I was quite shocked when it did.  

[Bm2016]

it was a long time ago, I may not able recall every detail, they just numbed the area of skin at liver, the procedure was quick, like around 15 minutes. they spent more time trying to find a good spot to insert the needle. while they use the spring loaded syringe on my first time biopsy, it was like bang, a pitching pain that lasted like 1 second,  that was it, they did  put something on my hand/wrist for inter-venous with a bag of clear liquid, my guess it was saline solution to prevent dehydration for the 4 hours i laid on my right side, i did get a very mild pain around the right shoulder area that lasted a few days, and they did warned me before hand. at the time I was not obese, maybe they were able to find my liver easier,

the 2nd time was ultrasound guided, i felt the long needle was swinging inside, and some mild, grinding pain. the doctor explained it was from the diaphragm as the liver has no pain nerves,  whatever medication they put on me, i was cohere and able to listen and talk, but also a little disoriented, and pain in upper right quadrant limits to slow body movement, also got the neck/shoulder pain that lasted a few days as well.

[Liverpatient]

Thanks again both of you for sharing your history about liver biopsy. What worries me is actually not the pain itself which can be tackled with painkillers and with rest and time, but the possible complications that may arise. I'm particularly afraid of internal bleeding, and infection.

[Bravesoul]

Ahan. Do you live in the USA?

[Bravesoul]

If one's HBV DNA levels are above 2000iu which yours are, and alt levels are elevated which yours are as well, then most guidelines would indeed indicate treatment. I think you should consider going on treatment regardless of liver biopsy because even if the biopsy didn't indicate much damage just yet, you're likely to experience damage in future without treatment (inferring by your high ALT). To be on the safe side, start treatment man. It will keep your liver in an optimal shape for when a cure comes out, your liver would be able to handle the therapeutic 'flares' without significant damage.

[Liverpatient]

Hi, thanks for the reply again. And, yes, I've recently asked my gp tp put me on treatment, but, I doubt it if they are going to start treatment before they eventually do a liver biopsy on me.

[nareshdinesh]

Did I get the biopsy done?

[Liverpatient]

No, I've postponed it for some future time. I'm too unsure with regards the benefits vis-a-vis the risks of the procedure.

[nareshdinesh]

My liver biopsy was done while my gall bladder was removed. I was under general anaesthesia. No side effect. I could recover the gall bladder surgery in a week' time.

Liver biopsy revealed:  
1. Steatosis 10%
2. Mild Hepatitis (NASH).
3. Portal fibrosis 2/6 (Ishak stage)
4. HAI = 2+1+0+0 = 3/18

[Liverpatient]

Hi, I guess, since they had to surgically open your abdominal cavity in order to remove your gallbladder the liver biopsy on you was probably done not through the traditional way by inserting a long niddle into your liver from out side. But instead, they could simply take a sample from your liver while your abdomen is opened for the removal of the gallbladder. Anyway I wish you are doing well now and God bless.

[nareshdinesh]

Hi.. my MRE revealed just 2.1KPA stiffness and Liver function tests too appeared okay... but the biopsy.. which was just done incidentally when my Gall blade was removed last year revealed that I had NASH and portal fibrosis 2/6. At leader my experience shows that imaging or elastograms don't detect the problem early enough.

[Liverpatient]

Hi, sorry to know that you've to endure the removal of your gallbladder but I wish you are doing well now. My highest FibroScan score so far has been ca 5,7KPa, and the ultrasound has not revealed any problems yet. Despite this fact, I've always had the feeling that may be these non-invasive diagnostics are missing some important details, something that you experienced. But I've to say I'm very scared of my forthcoming liver biopsy, especially after reading a lot of scary stories about it in the hepatitis C community.
How was your liver biopsy, could you share your experience? Thanks.

[Bravesoul]

Why would your doctor suggest it in the first place?

[Liverpatient]

Hi, it came also as a little shock to me when I received the referal. Though my lft tests, FibroScan, and ultrasound have so far been in the normal range, I've had quite bad physical health, have been feeling not good for some time now; plus I'm soon 45 years old, with hbv dna reaching upto 3000IU/ml, alt reaching upto 40, and hbsag quantity upto 17000IU/ml. Probably my doctor wants to have a closer look at my liver, because, I guess the biopsy is still the gold standard of the liver diagnostics; nothing can beat having a real sample of the liver and examining it for various issues, such as fibrosis, and hcc. I aslo think my doctor wants to make a decision on whether to put me on treatment for chronic hepB.

[JaeLong42069]

Im scared myself. But do what you have to do to make sure ur.okay! My dad had it done...he.said it wasnt bad at all...im scared of things.like that too but after going what.i am going thru ! Id do it because nothing is worth ur health or your family.my dad did it and he was fine the same day.
.. God bless you dont stress yourself too much brother you will be fine...a biopsy is nothing compared to what could happen if theres something u need to know and you dont figure it out asap.you need to know...dr. Google will tell u the worst of the worst. Dont let google scare you please..good luck

[Liverpatient]

Thanks for the ecouragement. I've for now decided to postpone the biopsy; but as you said, it is good to find out what is really going on with the liver. It becomes esp. important when one is older in his forties like me, becasue with time more damage is done to the liver.
I will certainly do the biopsy, though not right now, I need to convince my self more:) And if my doctor insists biopsy before he could eventually put me on treatment, then I'm definitely going for it.

[JaeLong42069]

I will keep you in my prayers, GOD Bless you and your family.

[Liverpatient]

Thanks a lot for the kind words, God bless you and the rest as well. We have to keep the hope alive, I hope all of us will be cured of hepB very soon. I hope also the scientists will finally crack the code of cccDNA to cure us of this terrible disease, just like what they did wth hepC.

[Liverpatient]

*lungs and intestine