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.
. International Classification of Disease (ICD 2007) – WHO classification:
- Chapter XI: Diseases of the digestive system
- 403.776.409.405 same as “Gastroenterology”
- 552 Liver Diseases
- 130 Biliary Tract Diseases
- 689 Pancreatic diseases
- WI 700-740 Liver and biliary tree Diseases
- WI 800-830 Pancrease