Hepatology is the sub specialty in Gastroenterology which deals with the study, analysis, prevention and administration of ailments that influence Liver. Liver is the vital organ which plays a major role in metabolism. Liver is highly specialized and regulates a wide range of high volume biochemical reactions. Liver weighs about 1.44-1.66 kgs located at upper right quadrant of abdominal cavity and rests below diaphragm to the right of the stomach and overlies the gallbladder. Liver diseases are also termed as hepatic disease. Most commonly found liver disease includes Hepatitis, Jaundice, Cirrhosis, Alcoholic Liver Disease, Non-Alcoholic Fatty Liver and Liver Abscesses. Liver disease rarely results in pain, portal hypertension and immunosuppression.

Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology, rapid expansion has led in some countries to doctors specializing solely on this area, who are called hepatologists.

Diseases and complications related to viral hepatitis and alcohol are the main reason for seeking specialist advice. More than two billion people have been infected with hepatitis B virus at some point in their life, and approximately 350 million have become persistent carriers. 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 however, 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 physicians from different disciplines. The reasons might be:

• Drug overdose. Paracetamol overdose is common.
• 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 like 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 gallstone

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

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Clinical Gastroenterology Journal
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