Hepatology

Medical specialty

This article is about the branch of internal medicine. For the compound literary or narrative work, see heptalogy. For the study of amphibians, see herpetology. For the study of liverworts, see hepaticology. For the journal, see Hepatology (journal).

HepatologistOccupation

Names| Doctor, Medical Specialist

Occupation type

| Specialty

Activity sectors

| Medicine
Description

Education required

* Doctor of Medicine (M.D.)

* Doctor of Osteopathic Medicine (D.O.)

* Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.)

* Bacculareus Medicinae, Bacculareus Chirurgiae (M.B.Ch.B)

AND

* Internal Medicine Specialiazation

AND

* Gastroenterology Subspecialization

AND

* Extra training as a Gastroenterologist in Hepatology and Transplant Hepatology

Fields of
employment

| Hospitals, clinics
Fluoroscopic image of common bile duct

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.[1] 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.[citation needed] In many countries, however, overall alcohol consumption is increasing, and consequently the number of people with cirrhosis and other related complications is commensurately increasing.[citation needed]

Schematic diagram of hepato-biliary system

## Scope of specialty

[edit]

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.

## History

[edit]

Dr. B Blumberg, awarded Nobel prize 1976 for discovery of hepatitis B virus

Evidence from autopsies on Egyptian mummies suggests that liver damage from the parasitic infection bilharziasis was widespread in the ancient society.[2] It is possible that the Greeks may have been aware of the liver's ability to exponentially duplicate as illustrated by the story of Prometheus. However, knowledge about liver disease in antiquity is questionable. Most of the important advances in the field have been made in the last 50 years.[when?]

* In 400 BC Hippocrates mentioned liver abscess in aphorisms.[3]
* Roman anatomist Galen thought the liver was the principal organ of the body. He also identified its relationship with the gallbladder and spleen.[4]
* Around 100 CE Aretaeus of Cappadocia wrote on jaundice[5]
* In the medieval period Avicenna noted the importance of urine in diagnosing liver conditions.
* In 1770, French anatomist Antoine Portal noted bleeding due to oesophageal varices,[6]
* In 1844, Gabriel Valentin showed pancreatic juices break down food in digestion.
* 1846 Justus Von Leibig discovered pancreatic juice tyrosine[5]
* 1862 Austin Flint described the production of "stercorin".
* 1875 Victor Charles Hanot described cirrhotic jaundice and other diseases of the liver[7]
* In 1958, Moore developed a standard technique for canine orthotopic liver transplantation.[8]
* The first human liver transplant was performed in 1963 by Dr. Thomas E. Starzl on a three-year-old male afflicted with biliary atresia after perfecting the technique on canine livers.[9][10]
* Baruch S. Blumberg discovered hepatitis B virus in 1966 and developed the first vaccine against it 1969. He was awarded the Nobel Prize in Physiology or Medicine 1976.[11]
* In 1989, investigators from the CDC (Daniel W. Bradley) and Chiron (Michael Houghton) identified the hepatitis C virus, which had previously been known as non-A, non-B hepatitis and could not be detected in the blood supply.[12]
* Only in 1992 was a blood test created that could detect hepatitis C in donated blood.[12]

The word hepatology is from Ancient Greek ἧπαρ (hepar) or ἡπατο- (hepato-), meaning "liver", and -λογία (-logia), meaning "study".

## Disease classification

[edit]

1\. International Classification of Disease (ICD 2007) – WHO classification:

* Chapter XI: Diseases of the digestive system[13]
* K70-K77 Diseases of liver
* K80-K87 Disorders of gallbladder, biliary tract and pancreas

2\. MeSH (medical subject heading):sam

* G02.403.776.409.405 same as "Gastroenterology"[14]
* C06.552 Liver Diseases[15]
* C06.130 Biliary Tract Diseases[16]
* C06.689 Pancreatic diseases[17]

3\. National Library of Medicine Catalogue[18]

* WI 700-740 Liver and biliary tree Diseases[19]
* WI 800-830 Pancrease[20]

Also see Hepato-biliary diseases

## Important procedures

[edit]

* Endoscopic retrograde cholangiopancreatography (ERCP)
* Transhepatic pancreato-cholangiography (TPC)
* Transjugular intrahepatic portosystemic shunt (TIPSS)
* Liver transplant and pancreas transplant

## See Also

[edit]

* Journal of Clinical and Translational Hepatology

## References

[edit]

1. ^ "WHO | Hepatitis B". Retrieved 2010-03-17.
2. ^ Rosalie David A, Contis G (1996). "Paleopathology on schistosomiasis in Egyptian mummies". Parasitol. Today (Regul. Ed.). 12 (4): 167. doi:10.1016/0169-4758(96)80811-8. PMID 15275234.
3. ^ "Aphorisms.mb.txt". Archived from the original on 11 February 2005. Retrieved 30 November 2021.
4. ^ "History of Liver, Gallbladder, and Spleen". Retrieved 18 May 2007.
5. ^ a b H. S.J. Lee, ed. (1999). Dates in Gastroenterology: A Chronological Record of Progress in Gastroenterology over the Last Millennium (Landmarks in Medicine). Informa Healthcare. ISBN 1-85070-502-X.
6. ^ Moodley J; Singh B; Lalloo S; Pershad S; et al. (2001). "Non-operative management of haemobilia". The British Journal of Surgery. 88 (8): 1073–76\. doi:10.1046/j.0007-1323.2001.01825.x. PMID 11488792. S2CID 8124234.
7. ^ "Victor Charles Hanot". Whonamedit.com. Retrieved 18 May 2007.
8. ^ "eMedicine - History of Pediatric Liver Transplantation : Article by Beth A Carter, MD". Emedicine.com. Retrieved 18 May 2007.
9. ^ "History of Liver Transplantation". Archived from the original on August 30, 2009. Retrieved 8 September 2009.
10. ^ STARZL TE; MARCHIORO TL; VONKAULLA KN; HERMANN G; et al. (1963). "Homotransplantation Of The Liver In Humans". Surgery, Gynecology & Obstetrics. 117: 659–76\. PMC 2634660. PMID 14100514.
11. ^ "Baruch S. Blumberg - Autobiography". Nobelprize.org. Retrieved 18 May 2007.
12. ^ a b "Brief_History_HCV_10.pdf" (PDF). Archived from the original (PDF) on 2014-09-25. Retrieved 2013-06-18.
13. ^ "Archived copy". Archived from the original on 2009-04-22. Retrieved 2020-10-05.`{{cite web}}`: CS1 maint: archived copy as title (link)
14. ^ "G02.403.776.409.405 same as "Gastroenterology"". Nlm.nih.gov. Retrieved 30 November 2021.
15. ^ "Liver Diseases". Nih.gov. Retrieved 24 December 2016.
16. ^ "Biliary Tract Diseases". Nih.gov. Retrieved 24 December 2016.
17. ^ "Pancreatic Diseases". Nih.gov. Retrieved 24 December 2016.
18. ^ "NLM Classification Home Page". Nih.gov. Archived from the original on October 18, 2004. Retrieved 24 December 2016.
19. ^ "NLM Classification Schedule WI". wwwcf.nlm.nih.gov. Archived from the original on 19 October 2004. Retrieved 17 January 2022.
20. ^ "NLM Classification Schedule WI". wwwcf.nlm.nih.gov. Archived from the original on 19 October 2004. Retrieved 17 January 2022.

* v
* t
* e

Diseases of the human digestive system

Upper GI tract|

| Esophagus|

* Esophagitis
* Candidal
* Eosinophilic
* Herpetiform
* Rupture
* Boerhaave syndrome
* Mallory–Weiss syndrome
* Zenker's diverticulum
* Barrett's esophagus
* Esophageal motility disorder
* Nutcracker esophagus
* Achalasia
* Esophagogastric junction outflow obstruction
* Diffuse esophageal spasm
* Gastroesophageal reflux disease (GERD)
* Laryngopharyngeal reflux (LPR)
* Esophageal stricture
* Inlet patch
* Megaesophagus
* Esophageal intramural pseudodiverticulosis
* Acute esophageal necrosis

|

Stomach|

* Gastritis
* Atrophic
* Ménétrier's disease
* Gastroenteritis
* Peptic (gastric) ulcer
* Cushing ulcer
* Dieulafoy's lesion
* Dyspepsia
* Functional dyspepsia
* Pyloric stenosis
* Achlorhydria
* Gastroparesis
* Gastroptosis
* Portal hypertensive gastropathy
* Gastric antral vascular ectasia
* Gastric dumping syndrome
* Gastric volvulus
* Buried bumper syndrome
* Gastrinoma
* Zollinger–Ellison syndrome

Lower GI tract
Enteropathy|

| Small intestine
(Duodenum/Jejunum/Ileum)|

* Enteritis
* Duodenitis
* Jejunitis
* Ileitis
* Peptic (duodenal) ulcer
* Curling's ulcer
* Malabsorption: Coeliac
* Tropical sprue
* Blind loop syndrome
* Small intestinal bacterial overgrowth
* Whipple's
* Short bowel syndrome
* Steatorrhea
* Milroy disease
* Bile acid malabsorption

|

Large intestine
(Appendix/Colon)|

* Appendicitis
* Colitis
* Pseudomembranous
* Ulcerative
* Ischemic
* Microscopic
* Collagenous
* Lymphocytic
* Dysentery
* Functional colonic disease
* IBS
* Intestinal pseudoobstruction / Ogilvie syndrome
* Megacolon / Toxic megacolon
* Diverticulitis/Diverticulosis/SCAD

Large and/or small|

* Enterocolitis
* Necrotizing
* Gastroenterocolitis
* IBD
* Crohn's disease
* Vascular: Abdominal angina
* Mesenteric ischemia
* Angiodysplasia
* Bowel obstruction: Ileus
* Intussusception
* Volvulus
* Fecal impaction
* Constipation
* Functional
* Diarrhea
* Infectious
* Intestinal adhesions

Rectum|

* Proctitis
* Radiation proctitis
* Proctalgia fugax
* Rectal prolapse (Internal rectal prolapse)
* Anismus
* Solitary rectal ulcer syndrome
* Rectal stricture

Anal canal|

* Anal fissure/Anal fistula
* Anal abscess
* Hemorrhoid
* Anal dysplasia
* Pruritus ani
* Anal stricture

GI bleeding|

* Blood in stool
* Upper
* Hematemesis
* Melena
* Lower
* Hematochezia

Accessory|

| Liver|

* Hepatitis
* Viral hepatitis
* Autoimmune hepatitis
* Alcoholic hepatitis
* Cirrhosis
* PBC
* Fatty liver
* MASLD
* Vascular
* Budd–Chiari syndrome
* Hepatic veno-occlusive disease
* Portal hypertension
* Nutmeg liver
* Alcoholic liver disease
* Liver failure
* Hepatic encephalopathy
* Acute liver failure
* Liver abscess
* Pyogenic
* Amoebic
* Hepatorenal syndrome
* Peliosis hepatis
* Metabolic disorders
* Wilson's disease
* Hemochromatosis

|

Gallbladder|

* Cholecystitis
* Gallstone / Cholelithiasis
* Cholesterolosis
* Adenomyomatosis
* Postcholecystectomy syndrome
* Porcelain gallbladder

Bile duct/
Other biliary tree|

* Cholangitis
* Primary sclerosing cholangitis
* Secondary sclerosing cholangitis
* Ascending
* Cholestasis/Mirizzi's syndrome
* Biliary fistula
* Haemobilia

* Common bile duct
* Choledocholithiasis
* Biliary dyskinesia
* Sphincter of Oddi dysfunction

Pancreatic|

* Pancreatitis
* Acute
* Chronic
* Hereditary
* Pancreatic abscess
* Pancreatic pseudocyst
* Exocrine pancreatic insufficiency
* Pancreatic fistula

Other|

| Hernia|

* Diaphragmatic
* Congenital
* Hiatus

* Inguinal
* Indirect
* Direct
* Umbilical
* Paraumbilical
* Femoral
* Obturator
* Spigelian

* Lumbar
* Petit's
* Grynfeltt–Lesshaft

* Undefined location
* Incisional
* Internal hernia
* Richter's

|

Peritoneal|

* Peritonitis
* Spontaneous bacterial peritonitis
* Hemoperitoneum
* Pneumoperitoneum

* v
* t
* e

Medicine

Specialties
and
subspecialties|

| Surgery|

* Cardiac surgery
* Cardiothoracic surgery
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* Eye surgery
* General surgery
* Colorectal surgery
* Digestive system surgery
* Neurosurgery
* Oral and maxillofacial surgery
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* Plastic surgery
* Reproductive surgery
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* Transplant surgery
* Trauma surgery
* Urology
* Andrology
* Vascular surgery

|

Internal
medicine|

* Allergy / Immunology
* Angiology
* Cardiology
* Endocrinology
* Gastroenterology
* Hepatology
* Geriatrics
* Hematology
* Hospital medicine
* Infectious diseases
* Nephrology
* Oncology
* Pulmonology
* Rheumatology

Obstetrics and
gynaecology|

* Gynaecology
* Gynecologic oncology
* Maternal–fetal medicine
* Obstetrics
* Reproductive endocrinology and infertility
* Urogynecology

Diagnostic|

* Radiology
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* Neuroradiology
* Nuclear medicine
* Pathology
* Anatomical
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* Cytopathology
* Medical microbiology
* Transfusion medicine

Other|

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* Neurosurgical anesthesiology
* Aviation medicine
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Medical
education|

* Medical school
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Related topics|

* Allied health
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