Form: D-5911 How to Prepare for Your Liver Biopsy For patients of the Francis Family Liver Clinic Read this pamphlet to learn about: What a liver biopsy is How to prepare for the biopsy What to expect before and after the biopsy The Clinic Nurse will contact you about the instructions you need to follow for your upcoming biopsy. The nurse will also confirm the date, time and location of your biopsy appointment and follow-up clinic visit. Biopsy Date: Biopsy Time: Follow-Up Date: Follow-Up Time: See pages 5 or 6 for biopsy location
Where is my liver? Your liver is in your abdomen, below your diaphragm. It is on the right side, behind the ribs. What is a liver biopsy? A liver biopsy is a minor procedure. A doctor will take a tiny piece of your liver with a biopsy needle. Then a pathologist will look at it under a microscope. Why do I need a liver biopsy? A liver biopsy can help your doctor and/or nurse practitioner: Confirm what they think is wrong with your liver Find the cause of liver disease Find out how much scarring or damage is in your liver 2
What will happen during the liver biopsy? 1. You will get pain medicine and a medicine to relax you (sedative). 2. A doctor will do the biopsy. 3. Nurses will watch you for 2 to 4 hours after the biopsy. This is to make sure there are no complications (nothing has gone wrong). Preparing for your liver biopsy Important: The clinic nurse will contact you to go over these instructions. If you do not follow these instructions, the hospital may CANCEL your biopsy. 1. Tell your doctor, nurse practitioner or the clinic nurse if you have had any drug-eluting or bare-metal stents inserted within the last 12 months. 2. Get your blood tests done 7 to 14 days before your biopsy, preferably at UHN. (See last page for UHN blood lab locations). 3. Arrange to take a full day off from work on the day of your biopsy. 4. Arrange to have someone pick you up, take you home, and stay with you overnight after the biopsy. 5. Don t take any garlic, gingko, or ginseng pills (herbal medications) during the 7 days before your biopsy. Cooking with small amounts is OK. 6. You may need to stop taking blood thinning medicine before your biopsy. If you have any kidney related issues or conditions, tell your doctor, nurse practitioner or the nurse. 3
The table below is only a guideline. Your doctor, nurse practitioner or the clinic nurse may have more specific instructions for you. Medication Acetylsalicylic acid (Aspirin), ibuprofen (Advil, Motrin), naproxen (Aleve) or indomethacin When to stop taking 7 days before biopsy Clopidogrel (Plavix), prasugrel (Effient) or ticagrelor (Brillinta) 7 days before biopsy Warfarin (Coumadin) 5 days before biopsy (another medicine may be prescribed if needed) Dabigatran (Pradaxa) 3 to 4 days before biopsy (if kidney function is normal) Rivaroxaban (Xarelto), apixaban (Eliquis) or edoxaban (Lixiana) 48 hours before biopsy (if kidney function is normal) Dalteparin (Fragmin), enoxaparin (Lovenox) or tinzaparin (Innohep) 24 hours before biopsy (if kidney function is normal) Fondaparinux (Arixtra) and argatroban (Acova) Please consult blood specialist (hematologist) If you take medicines that are not listed in the table and you are not sure what to do, please talk with your doctor or nurse practitioner. 4
3 types of liver biopsies Your doctor or nurse practitioner will tell you which biopsy you are having. The nurse will tell you the location when he or she calls you. 1. Ultrasound Guided Biopsy A radiologist will use an ultrasound to guide the needle through the abdomen towards the liver. Then he/she will quickly insert the needle and take a tiny piece of your liver. 2. Trans-jugular Biopsy (through a vein) A radiologist will put a small tube into a vein in your neck. He/she will guide it into your liver using x-ray. Then he/she will insert a small biopsy needle through the tube and remove a tiny piece of your liver. Toronto General Hospital Medical Imaging 200 Elizabeth St, Munk Building 1st Floor (Room 1W 407) Toronto Western Hospital Medical Imaging 399 Bathurst St, McLaughlin Wing 3rd Floor (Room 3MCL) Important: Nothing to eat or drink 6 to 8 hours before your procedure 3. Percutaneous Biopsy (through the skin) The hepatologist (liver specialist) will make a very small cut on your skin. Then he/she will quickly insert a needle and take a tiny piece of your liver through the cut. Toronto General Hospital Medical Day Unit 200 Elizabeth St, Norman Urquhart Building 2nd Floor (Room 2NU 237) Important: On the day of the procedure, have a light breakfast including some fat (like dairy products such as milk, yogurt) 5
After the biopsy We will give you more information and instructions after the biopsy Remember: You should not go out of town for at least 7 days after your biopsy. If you have questions about when to restart any medications you may have stopped before your biopsy, please ask the doctor or nurse practitioner who prescribed them. You may have some pain after the biopsy. Take only acetaminophen (Tylenol) and follow the instructions on the pill bottle. Go to the nearest hospital Emergency Department if you have: a lot of pain (abdomen or back) a lot of bleeding Tell the hospital staff that you recently had a liver biopsy. 6
If you have questions or concerns Call the Liver Clinic Nurse at 416 340 3667 Diagnostic Test Centre/Blood Collection Lab Toronto General Hospital Eaton Building Ground Floor (Room EG-406) Toronto Western Hospital Main Pavilion 1st Floor, (Room 1M-405) Princess Margaret Cancer Centre Main Floor, (Room M-624) Doing your tests at UHN is best. If you cannot go to one of our labs, let the nurse know and we will fax a requisition to your local medical lab service (such as LifeLabs, DynaCare or, Alpha). Visit www.uhnpatienteducation.ca for more health information. Contact us to provide feedback or request this brochure in a different format, such as large print or electronic formats: pfep@uhn.ca 2018 University Health Network. All rights reserved. Use this material for your information only. It does not replace advice from your doctor or other health care professional. Do not use this information for diagnosis or treatment. Ask your health care provider for advice about a specific medical condition. You may print 1 copy of this brochure for non-commercial and personal use only. Form: D-5911 Author: Sharlene Camaya and Colina Yim / Updated by Jethro Mercado Revised: 06/2018