Hepatology

Hepatology

The field of liver disease. The liver is the body's largest organ and hepatology is a large field. It includes, but is not limited to, the study of acute and chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, liver transplantation, drug metabolism (which depends largely upon the liver), and immunology as it pertains to the liver. Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. .

Diseases and complications related to viral hepatitis and alcohol are the main reason for seeking specialist advice. Up to 80% of liver cancers can be attributed to either hepatitis B or Hepatitis C virus. In terms of mortality, the former is second only to smoking among known agents causing cancer. With more widespread implementation of vaccination and strict screening before blood transfusion, lower infection rates are expected in the future. In many countries, though, overall alcohol consumption is increasing, and consequently the number of people with cirrhosis and other related complications is commensurately increasing.

Scope of specialty

As for many medical specialties, patients are most likely to be referred by family physicians ( i.e. GP) or by doctors from different disciplines. The reasons might be:

• Gastrointestinal bleeding from portal hypertension related to liver damage

• Abnormal blood test suggesting liver disease

• Enzyme defects leading to bigger liver in children commonly named storage disease of liver

• Jaundice / Hepatitis virus positivity in blood, perhaps discovered on screening blood tests

• Ascites or swelling of abdomen from fluid accumulation, commonly due to liver disease but can be from other diseases like heart failure

• All patients with advanced liver disease e.g. cirrhosis should be under specialist care

• To undergo ERCP for diagnosing diseases of biliary tree or their management

• Fever with other features suggestive of infection involving mentioned organs. Some exotic tropical diseases hydatid cyst, kala-azar or schistosomiasis may be suspected. Microbiologists would be involved as well.

• Systemic diseases affecting liver and biliary tree e.g. haemochromatosis

• Follow up of liver transplant

• Pancreatitis - commonly due to alcohol or gall stone

• Cancer of above organs. Usually multi-disciplinary approach is undertaken with involvement of oncologist and other experts