The common method of Liver biopsy is done by passing a needle quickly into and out of the liver. The procedure is done after giving anesthesia to the skin and area under the skin. Physician determines the best site, depth and angle of the needle puncture by physical examination or ultrasound.

Transvenous liver biopsy is performed by a radiologist in which a small tube is inserted into the internal jugular vein in the neck and radiological guided into the hepatic vein, which drains the liver.
A small biopsy needle is then inserted through the tube and directly into the liver to obtain a sample of tissue.
This biopsy technique is used in patients who have a significant problem with blood clotting (coagulopathy) or a large amount of fluid within the abdomen (ascites).

Who does a Liver biopsy ?
A Medical or Surgical Gastroenterologist or a General surgeon or a Radiologist can do Liver biopsy.

What is Liver test or Liver Enzyme Test ?
Liver test is done to examine the proper liver functioning. Doctor asks for a Liver function test if a disease affecting the liver is suspected. When the liver is not functioning properly, it releases enzymes from the liver cells into the blood. These enzymes can be analyzed in blood and the values of liver enzymes are determined.

What are the conditions in which the Liver enzymes are elevated ?

Cirrhosis of the Liver

Fatty Liver

Liver Cancer

Autoimmune Disorders

Toxic Levels of Chemicals or Drugs

Alcoholic Liver Disease

Viral Hepatitis

Obesity

Wilson's disease

Adrenal insufficiency

Celiac disease

Thyroid disorders

Muscle disorders

Non-Alcoholic Steato Hepatitis (NASH)

Hereditary hemochromatosis

Alpha-1-antitrypsin deficiency

Gallstones or Gallbladder Diseases

Diabetes

What are the liver enzymes which are tested for evaluating the normal functioning of the liver ?

Albumin

Bilirubin

Alkaline Phosphatase (ALP)

Alanine aminotransferase (ALT)

Aspartate aminotransferase (AST)

gamma-glutamyl transferase (GGT),

Lactic acid dehydrogenase (LDH), and

Prothrombin time (PT)

What are the dangers of Liver Biopsy ?
The primary risk of liver biopsy is bleeding from the site of needle entry into the liver, although this occurs in less than 1% of patients.
Some of the other possible complications include the puncture of other organs, such as the kidney, lung or colon.

What is Prothrombin Time (PT) ?
Prothrombin Time (PT) is a measure of how long it takes blood to clot. At least a dozen blood proteins, or blood clotting factors, are needed to clot blood and stop bleeding (coagulation). Prothrombin Time is an important coagulation test because it measures the presence and activity of five different blood clotting factors (factors I, II, V, VII, and X). Prothrombin levels are monitored to help evaluate liver function.

Are there alternatives to Liver Biopsy ?
The alternative method for diagnosis of liver abnormalities is physical examination of the patient, medical history, and blood testing.
In some cases, blood testing is quite accurate in giving the doctor the information to diagnose chronic liver disease, while in other circumstances a liver biopsy is needed to assure an accurate diagnosis.

Do you need Multiple Liver Biopsies ?
Mostly, single Liver biopsy is enough to confirm a suspected diagnosis of chronic liver disease. Occasionally, liver biopsy is repeated if the clinical condition changes, to evaluate the results of medical therapy, such as drug treatment. Patients who have undergone liver transplantation often require numerous liver biopsies in the early weeks to months following the surgery to allow accurate diagnoses of whether the new liver is being rejected or whether other problems have developed.

Chronic liver disease : Liver disease persisting over a long period of time.
Liver transplantation : Surgery to replace a disease liver with a healthy one from a donor.
Jugular vein : Veins in the neck which drain the brain, face, and neck into the brachiocephalic or sub-clavian veins.
Blood clotting : Number of different protein factors which, when acting together, can form a blood clot shortly after platelets have broken at the site of the wound.
Cirrhosis : Liver disease characterised pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ.
Auto immune disease : A disease process that involves the production of host antibodies to host tissue