[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Abdomen](https://durgical.com/en/clinical-exam/areas/abdomen/) › Endoscopy, laparoscopy and biopsies of liver, kidney, marrow and nodes

# Endoscopy, laparoscopy and biopsies of liver, kidney, marrow and nodes

- Topic

Tests that look inside the gut or belly with a camera, or take a small piece of an organ to study under the microscope.

Updated Nov 13, 2026

## Key points

- Upper endoscopy within the first day is the key study in upper GI bleeding.
- After endoscopy: nothing by mouth until the gag reflex returns.
- After liver biopsy: lie on the right side and watch for bleeding; transjugular route if clotting is poor or ascites.
- Kidney biopsy: bleeding is the main risk; watch urine colour and blood pressure.
- Bone marrow: posterior iliac crest; aspirate for cells, core for architecture.

## What it is

Endoscopy lets the team see the digestive lining directly, take biopsies and often treat in the same session. Diagnostic laparoscopy looks at the abdominal and pelvic cavity through small incisions. Needle biopsies of the liver, kidney, bone marrow and lymph nodes give tissue when blood tests and imaging cannot name the disease. All need consent, a check of bleeding risk and careful monitoring afterwards, which is where nursing care matters most.

## Key facts

- Endoscopy is diagnostic and therapeutic: it can stop bleeding, band varices, remove polyps and dilate strictures.
- Marrow aspirate shows cell morphology and is used for flow cytometry and genetics; the core biopsy shows cellularity, fibrosis and infiltration.
- A 'dry tap' on aspiration suggests marrow fibrosis or packed infiltration and makes the core biopsy essential.
- Fine-needle aspiration may detect metastasis, but lymphoma usually needs a core or excisional biopsy to see the node architecture.
- Liver biopsy is done less often now because blood markers and elastography can stage fibrosis.
- Biopsies are matched to histology: the specimen goes in the right medium (formalin, saline, culture) and is labelled at the bedside.

## Step by step

- Confirm indication, consent, fasting and identity.
- Review platelets, clotting tests, kidney function and use of anticoagulants or antiplatelets; the medical team decides any change.
- Record baseline vital signs and place a venous line for sedation.
- Help with positioning and keep the patient informed during the procedure.
- Label and send samples in the medium the laboratory requires.
- Afterwards, monitor vital signs, the puncture site, pain and, after kidney biopsy, urine colour.
- Teach warning signs: fever, increasing pain, black stools, vomiting blood, dizziness or bleeding at the site.

## Procedures, uses, care and risks.

| Procedure | Main uses | Preparation and nursing | Main risks |
| --- | --- | --- | --- |
| [Upper endoscopy (esophagogastroduodenoscopy)](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/) | Upper GI bleeding, dysphagia, persistent dyspepsia with alarm signs, varices in cirrhosis, Barrett esophagus surveillance, biopsies (Helicobacter, celiac disease) | Fasting about eight hours; dentures out; sedation and monitoring; nothing by mouth until the gag reflex returns | Perforation, bleeding after biopsy, sedation effects (slow breathing, low blood pressure) |
| [Colonoscopy](https://durgical.com/en/conditions/colorectal-cancer/) | Lower GI bleeding, change in bowel habit, anemia, colorectal cancer screening and polyp removal, inflammatory bowel disease | Low-residue diet and bowel cleansing the day before; watch hydration in older patients; sedation | Perforation, bleeding after polypectomy, dehydration from bowel preparation |
| Diagnostic laparoscopy | Chronic or unexplained abdominal or pelvic pain, staging of abdominal cancer, ascites or peritoneal disease of unknown cause, biopsy of the peritoneum or liver surface | Fasting, general anaesthesia, consent; shoulder-tip pain from the gas is common afterwards | Injury to bowel or vessels, bleeding, infection, anaesthetic risks |
| [Liver biopsy (percutaneous or transjugular)](https://durgical.com/en/conditions/cirrhosis/) | Cause and stage of liver disease when non-invasive tests are unclear, abnormal liver tests, some masses | Clotting tests and platelets checked; fasting; breath held during the puncture; then lie on the right side and watch vital signs for bleeding; transjugular route if clotting is poor or ascites is present | Pain (often in the right shoulder), internal bleeding, pneumothorax, injury to gallbladder, kidney or bowel |
| [Kidney biopsy](https://durgical.com/en/conditions/nephrotic-syndrome/) | Nephrotic syndrome in adults, unexplained fall in kidney function, persistent hematuria with proteinuria, transplant rejection | Blood pressure controlled, clotting checked, prone position, ultrasound guidance; bed rest and watch urine colour, blood pressure and hemoglobin | Bleeding (hematuria, perirenal hematoma), rarely needing transfusion; infection |
| [Bone marrow aspiration and biopsy](https://durgical.com/en/conditions/aplastic-anaemia/) | Unexplained cytopenias, leukemia, lymphoma and myeloma staging, aplastic anemia, fever of unknown origin | Usually posterior iliac crest under local anaesthesia; pressure over the site afterwards | Bleeding at the site, rarely infection |
| [Lymph node biopsy (fine-needle aspiration, core or excisional)](https://durgical.com/en/conditions/hodgkin-lymphoma/) | Persistent unexplained node, suspected lymphoma, metastasis or tuberculosis | Local anaesthesia for needle biopsy; excisional biopsy in theatre; samples sent fresh when lymphoma is suspected | Bleeding, infection, nerve injury in the neck (excision) |

## Test yourself

Think of the answer, then tap the question to see it.

## Why must a patient not eat or drink right after an upper endoscopy?

Throat anaesthesia and sedation blunt the gag reflex, so food or fluid could be aspirated until it returns.

## When is a transjugular liver biopsy chosen instead of a percutaneous one?

When clotting is poor or there is significant ascites, because the needle reaches the liver from inside the hepatic vein.

## What does the nurse watch after a kidney biopsy?

Bleeding: urine colour, blood pressure, pulse, pain in the flank and hemoglobin, with bed rest for the first hours.

## Why does suspected lymphoma usually need more than a fine-needle aspiration?

Because classifying lymphoma requires the node's architecture, which a core or excisional biopsy preserves.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/endoscopy-laparoscopy-and-biopsies-of-liver-kidney-marrow-and-nodes/)

## Elsewhere in DurgiPedia

- [Biopsy: excisional, incisional, core needle, punch and fine-needle aspiration](https://durgical.com/en/general-pathology/biopsy-excisional-incisional-core-needle-punch-and-fine-needle-aspiration/)
- [Hematopoiesis and bone marrow](https://durgical.com/en/histology/hematopoiesis-and-bone-marrow/)
- [Approach to a neck lump in adults](https://durgical.com/en/ent/approach-to-a-neck-lump-in-adults/)

## Connections

## Related 6

- [Upper and lower gastrointestinal bleeding](https://durgical.com/en/clinical-exam/upper-and-lower-gastrointestinal-bleeding/)
- [Digital rectal examination](https://durgical.com/en/clinical-exam/digital-rectal-examination/)
- [Portal hypertension and the signs of chronic liver disease](https://durgical.com/en/clinical-exam/portal-hypertension-and-the-signs-of-chronic-liver-disease/)
- [Nephrotic vs nephritic syndrome](https://durgical.com/en/clinical-exam/nephrotic-vs-nephritic-syndrome/)
- [Lymph node examination](https://durgical.com/en/clinical-exam/lymph-node-examination/)
- [Which imaging study for which question: abdomen, kidney, blood, brain](https://durgical.com/en/clinical-exam/which-imaging-study-for-which-question-abdomen-kidney-blood-brain/)

## Related conditions 7

- [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/)
- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)
- [Barrett oesophagus](https://durgical.com/en/conditions/barrett-oesophagus/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Nephrotic syndrome](https://durgical.com/en/conditions/nephrotic-syndrome/)
- [Aplastic anaemia](https://durgical.com/en/conditions/aplastic-anaemia/)
- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: [EGD - esophagogastroduodenoscopy: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003888.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Liver biopsy: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003895.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Kidney biopsy: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003907.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Bone marrow biopsy: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003934.htm) (MedlinePlus, U.S. National Library of Medicine, 2026).

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Source: https://durgical.com/en/clinical-exam/endoscopy-laparoscopy-and-biopsies-of-liver-kidney-marrow-and-nodes/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/endoscopy-laparoscopy-and-biopsies-of-liver-kidney-marrow-and-nodes/