Liver biopsy is most accu- rate in disorders causing diffuse changes throughout the liver and is subject to sampling error in focal disorders. Liver biopsy should not be the initial procedure in the diagnosis of cholestasis. The biliary tree should first be assessed for signs of obstruction. Contraindications to performing a percutaneous liver biopsy include significant ascites and prolonged INR. Under these circumstances, the biopsy can be per- formed via the transjugular approach.