Hepatology

A hepatologist specialises in disorders involving the liver. Hepatology is often considered a branch of gastroenterology.

Medical Conditions

Hepatitis - numerous infections, particularly viral, can affect the liver. Hepatitis A, B, C, EBV (Epstein Barr Virus) and CMV (cytomegalovirus) are the most common viral forms of hepatitis seen in the Australian community.
Inflammatory liver disease
Vascular liver disorders
Liver cirrhosis - many diseases result in scarring of the liver. Whilst the causes are many and are often preventable if addressed early (e.g. alcohol, infection, autoimmune disease, metabolic disorders) the end result is similar.
Liver failure - Patients may develop jaundice (yellow skin) because of a build up of bilirubin - a breakdown product of red blood cells that is normally metabolised by the liver. They are prone to infection, have a tendency to bleed, have trouble with metabolising food and may become hypoglycaemic (low sugar level). When severe they may become encephalopathic (confused) because the liver fails to break down some toxic substances within the blood.
Oesophageal varices - Liver failure may cause dilation of large veins around the lower oesophagus and stomach. These may bleed, sometimes torrentially and hepatologists and gastroenterologists have expertise in managing this serious complication of liver cirrhosis.
Biliary disorders (problems with the gall bladder and ducts that lead to and drain it).
Pancreatitis
Primary sclerosing cholangitis
Hepatoma or hepatocellular carcinoma (liver cancer)
Other liver tumours

Specialty Areas of Interest

Liver failure and transplant
Paediatric hepatology
Alcoholic liver disease
Biliary stenting
Liver tumours

Associated Tests

Blood tests - to determine the severity of the liver problem, its likely cause and any complications that may have resulted from it.
Imaging studies such as ultrasound, CT scan, ERCP (endoscopic retrograde cholangio pancreatography).
Biopsy - where a small sample of liver tissue is taken and sent for analysis by a pathologist to determine the cause of an abnormality.
Endoscopy - a telescopic tube is passed through the mouth and down into the stomch and beyond to check for ulcers, oesophageal varices, tumour, bile duct pathology or other problems involving the upper gastrointestinal tract.

Procedures

Endoscopy
Variceal banding and sclerotherapy
TIPPS procedure (transjugular intrahepatic portosystemic shunt)
ERCP (endoscopic retrograde cholangio pancreatography)
Liver biopsy
Liver transplant

What to expect

History

Your hepatologist will begin by asking about your symptoms and how they affect you. They will ask about how your illness has developed and will ask about specific risk factors. These may include travel, dietary history, alcohol and drug use, family history, and coexisting medical problems.
They will also ask about past medical problems and treatments to date and current medications. Allergies and social history are also important.

Examination

Liver disease can be caused by many different disease processes and can also result in many different widespread complications.
The examination conducted by your hepatologist will be general. They usually begin by examining the finger nails, hands, arms, eyes and face, chest and then abdomen and liver specifically. Findings will guide the further investigations they order.