What is Hepatology?

Hepatology is a branch of medicine concerned with the study, prevention, diagnosis and management of diseases that affect the liver, gallbladder, biliary tree and pancreas. The term hepatology is derived from the Greek words “hepatikos” and “logia,” which mean liver and study, respectively.

Hepatitis affects millions of individuals globally and is associated with several poor outcomes including liver transplant and liver cancer. In particular, hepatitis B and hepatitis C are major causes of liver cancer, while alcohol abuse has been linked to conditions such as cirrhosis and other serious complications. The conditions hepatologists deal with most frequently are viral hepatitis and alcohol-related liver disease.

Some of the most common ailments that are assessed, diagnosed and managed by a hepatologist include:

• Diseases of the liver related to excess alcohol consumption, including fatty liver disease, liver cirrhosis and liver cancer.
• Viral hepatitis infections (hepatitis A, B, C and E). Over two billion individuals have been infected with hepatitis B at some point and around 350 million people are persistent carriers. With widespread vaccination and blood screening, the incidence of hepatitis B has significantly decreased. However, hepatitis B and hepatitis C are accountable for up to 80% of liver cancer cases.
• Drug overdose, particularly paracetamol overdose
• Jaundice
• Gastrointestinal bleeding caused by portal hypertension linked to liver injury
• Enzyme defects causing liver enlargement in children, also known of as liver storage diseases
• Some tropical infections such as hydatid cyst, kala-azar or schistosomiasis
• Liver transplantation
• Liver cancer
• Genetic and metabolic liver disease
• Pancreatitis, usually when caused by alcohol consumption or gallstones
• Drug metabolism
• Damage to the pancreas or biliary tract caused by infection, cancer, alcohol, bleeding or obstruction.

The hepatologist

Hepatology used to be considered a subspecialty of gastroenterology, but nowadays doctors can specialize in hepatology, which is quickly emerging as a freestanding speciality. As a critical organ that can be affected by a large number of factors, the liver is usually the focal point in hepatology.

A hepatologist generally only assesses patients after they are referred by their doctor. A hepatologist may also be involved in the follow-up of patients who have received a liver transplant.

Some of the procedures hepatologists are required to perform include the following:

• Endoscopic retrograde cholangiopancreatography, which is used to diagnose and treat many biliary and pancreatic diseases.

• Transhepatic pancreato-cholangiography, whichis an X-ray used to detect obstruction in the bile ducts or liver.

• Transjugular intrahepatic portosystemic shunt, an artificial channel made to create a connection between the portal and hepatic veins.

In addition to caring for patients, a hepatologist may be involved in research looking at novel therapeutic approaches to disease or prevention methods such as screening, for example.