SIR YAHAYA MEMORIAL HOSPITAL

BIRNIN KEBBI
NURSING DEPARTMENT

LECTURE NOTE AND PRACTICAL DEMONSTRATION

ON

LIVER BIOPSY AND LIVER FUNCTION TEST (LFT)

BY

RN, CRNA YUSUF A. YUSUF

Page 1 of 7
 LIVER BIOPSY
A liver biopsy is a procedure in which a small needle is inserted into the liver
to collect a tissue sample.

The tissue is then analyzed in a laboratory to help diagnose a variety of

disorders and diseases in the liver. A liver biopsy is most often performed to
help identify the cause of:-

1. Persistent abnormal liver blood tests (liver enzymes)

2. Unexplained yellowing of the skin (jaundice)
3. A liver abnormality found on ultrasound, CT scan, or nuclear scan.
4. Unexplained enlargement of the liver.

A liver biopsy can also be used to estimate the degree of liver damage, to
grade and stage hepatitis B and C, and to determine the best treatment for the
damage or disease.

IS LIVER BIOPSY SAFE

In most instances, there are no complications in obtaining a liver biopsy.

However, rarely, internal bleeding may occur as well as a leak of bile from
the liver or gallbladder.

PREPARATION FOR LIVER BIOPSY

1. Ensure to ask whether the patient is pregnant, have a lung or heart

condition, or are allergic to any medications or have bleeding problems.
2. Discuss with patient about the procedure

Page 2 of 7
 3. Ask patient to do some necessary blood tests e.g. FBC, bleeding and
clothing profile.
4. Patient should be on NBM (nil by mouth) from 10pm
5. Is a day case, no admission is required.
6. A week before the procedure, do not take aspirin or product containing
aspirin , or NSAID
7. Check vital signs

DURING THE PROCEDURE OF LIVER BIOPSY

- The procedure which will take about 5minutes.

- Patient should wear theatre gown.
- Lie him/her on her back, with right elbow out to the side and your right
hand under your head. It is important that patient remain as still as
possible during the procedure.
- An ultrasound may be used to mark the location of the liver.
- Small dose of sedative may be given prior to the procedure.
- Clean and numb an area on the upper abdomen with local anaesthetic,
make a small incision on the upper abdomen and insert a needle into the
incision to take a small sample of liver tissue for analysis.

AFTER THE PROCEDURE

1. Patient will stay in a recovery room for up to 4hours for observation.

2. Minor pain or soreness may be feel at the biopsy site and discomfort or
due pain in your shoulder or back, if necessary a pain medication will
be prescribe to the patient.

Page 3 of 7
 3. Instruct patient not to drive or operate machinery for at least 8hours
after the procedure.
4. Avoid taking NSAID for one week after the procedure.
5. Discuss with patient when result is out

TWO METHODS OF LIVER BIOPSY ARE AVAILABLE:

1. Laparoscopic
2. Transvenuos

During a laparoscopic biopsy: a laparoscope (a thin lighted tube with a

camera attached) is inserted through an incision in the abdomen.

The laparoscope sends images of the liver to a monitor that you will watches
while using instruments to remove tissue samples from one or more parts of
the liver.

This type of biopsy may be used when tissue samples are needed from
specific part of the liver.

A TRANSVENOUS BIOPSY

May be done when patient have blood-clothing problems or fluid in the

abdomen. A biopsy needle is placed into the catheter and then into the liver to
obtain a sample.

WARNING SYMPTOMS AFTER LIVER BIOPSY

If any of the following occur within 72hours of the biopsy risk patient to
return to the hospital.

Page 4 of 7
Fever , dizziness, chills, difficulty breathing, chest pain, abdominal swelling
or bloating, increasing abdominal pain, tenderness or severe pain or redness
at the site of the biopsy.

LIVER FUNCTION TEST (LFT)

Liver function tests are blood test used to help diagnose and monitor liver
disease or damage. The tests measure the levels of certain enzymes and
proteins in your blood.

Some of these tests measure how well the liver is performing its normal
functions of producing protein and clearing bilirubin, a blood waste product.
Other liver function tests measure enzymes that liver cells release in response
to damage or disease.

INDICATIONS FOR LFT

1. Screen for liver infections such as hepatitis

2. Monitor the progress of a disease such as viral or alcoholic hepatitis,
and determine how well a treatment is working.
3. Measure the severity of a disease, particularly scarring of the liver
(cirrhosis).
4. Monitor possible side effects of medications.

SOME COMMON LIVER FUNCTION TEST INCLUDE

1. Alanine Transaminase (ALT): ALT is an enzyme found in the liver

that helps your body metabolize protein. When the liver is damage,
ALT is released into the bloodstream and levels increase.
Page 5 of 7
2. Aspartate Transaminase (AST): AST is an enzyme that helps
metabolize alanine, an amino acid like ALT, AST is normally present
in blood at low levels. An increase in AST levels may indicate liver
damage or disease or muscle damage.
3. Alkaline Phosphatase (ALP): ALP is an enzyme in the liver, bile
ducts and bone. Higher-than normal levels of ALP may indicate liver
damage or disease such as a blocked bile duct or certain bone disease.
4. Albumin and Total Protein: Albumin is one of several proteins made
in the liver, your body needs these proteins to fight infections and to
perform other functions. Lower-than-normal levels of albumin and total
protein might indicate liver damage or disease.
5. Bilirubin: Bilirubin is a substance produced during the normal
breakdown of Red blood cells. Bilirubin passes through the liver and is
excreted in stool. Elevated levels of bilirubin (jaundice) might indicate
liver damage or disease or certain types of anaemia.
6. Gamma-Glutamyltransferase (GGT): GGT is an enzyme in the
blood. Higher-than-normal levels may indicate liver or bile duct
damage.
7. L-Lactate dehydrogenase (LD): LD is an enzyme found in the liver.
Elevated levels may indicate liver damage but can be elevated in many
other disorders.
8. Prothrombin Time (PT): PT is the time it takes your blood to clot.
Increase PT may indicate liver damage but can also be elevated if you
are taking certain blood-thinning drugs, such as warfarin.

Page 6 of 7
 RESULTS
Normal blood test result for typical liver function tests include:

ALT: - 7 to 55 unit per litre (U/L)

AST: - 8 to 48 U/L

ALP: - 45 to 115 U/L

Albumin 3.5 to 5.0 grams per deciliter (g/dl)

Total Protein: - 6.3 to 7.9 g/dl

Bilirubin 0.1 to 1.2 milligrams per deciliter (mg/dl)

GGT 9 to 48 U/L

LD 122 to 222 U/L

PT 9.5 to 13.8 seconds

These results are typical for adult men. Normal results vary from
laboratory to laboratory and might be slightly different for women and
children.

Page 7 of 7