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What is Hepatology: An Overview

Definition & Overview

Hepatology is a branch of medicine that specialises in the diagnosis and treatment of diseases affecting the liver, gallbladder, pancreas, and the bile ducts. Doctors who specialise in it are called hepatologists.

In the course of their work, hepatologists perform various diagnostic tests, such as:

  • Liver function tests – These measure the body’s bilirubin, aspartate aminotransferase, antimitochondrial antibody, and alkaline phosphatase levels, among others.
  • Endoscopic retrograde cholangiopancreatography – An effective and accurate method to diagnose and treat most biliary and pancreatic diseases.
  • Transhepatic pancreato-cholangiography – An X-ray test that can detect any obstruction in the bile duct or liver.
  • Liver biopsy – A procedure used to take a tissue sample from the liver. The sample is then placed under microscopic examination. This is used to detect problems, such as malignant cells in the liver tissue.


In treating patients, hepatologists may also perform the following surgical procedures:

  • Liver transplant – Patients suffering from end-stage liver disease are evaluated to see if they are good candidates for a liver transplant. A liver that has become damaged beyond repair is replaced by a healthy liver taken from a donor. This is a major surgery that requires a lot of preparation, with the hepatologist and the patient’s primary care team working together closely. It is primarily important for the team of physicians to find a liver that is compatible with the patient.
  • Liver resection – A liver resection is a procedure that removes up to half of the liver, as long as the remaining part is healthy. This procedure is used when only a portion of the liver is diseased.
  • Gallbladder removal – This procedure removes the gallbladder if it is not functioning properly. Patients also have their gallbladder removed if they have too many gallstones or if the gallstones are causing an obstruction.
  • Proton beam therapy – This is a type of radiation treatment used to treat liver cancer. It works by destroying cancer cells using high-energy protons or positively charged particles.
  • Radiofrequency ablation therapy – This procedure is used to treat small liver tumours. It works by placing a needle electrode through the skin to access the tumour. High-frequency electrical currents are then passed through the electrode.
  • Transjugular intrahepatic portosystemic shunt – This procedure aims to make an artificial channel that connects the portal and hepatic veins.


In performing these procedures, hepatologists may use traditional or minimally invasive surgery. Minimally invasive procedures have become a popular alternative to open surgery. They help minimise the risks of bleeding, infection, and scarring that are commonly associated with all surgical procedures. By using these procedures, patients recover faster from surgery.

Hepatologists are also responsible for providing patients with advice on how liver problems can be prevented.

When Should You See a Hepatologist?

The top two most common reasons that prompt patients to seek the advice of a hepatologist are:

  • Viral hepatitis – Studies show that more than 2 billion people become infected with the hepatitis B virus. Out of this number, around 350 million become carriers of the virus.
  • Alcohol-related liver disease (ARLD) - Since the liver is responsible for filtering out toxins and harmful chemicals in the body, it also filters out alcohol. Every time it does, some healthy liver cells die. The liver is a very resilient organ, thanks to its ability to regenerate. However, if a person consumes too much alcohol regularly, the liver will not be able to heal itself. This may lead to permanent scarring of the liver. Alcohol-induced liver disease occurs in stages: (1) alcoholic fatty liver disease, (2) alcoholic hepatitis, and (3) cirrhosis.


These two are also the top causes of liver cancer. Other possible causes of liver problems include:

  • Enzyme defects that present at birth
  • Tropical infections, such as hydatid cyst, kala-azar, and schistosomiasis
  • Genetics
  • Drug overdose, most commonly from paracetamol
  • Trauma to the liver
  • Occupational exposure to blood products
  • Blood transfusions
  • Family history of liver disease


Patients suffering from the following can be treated by a hepatologist:

  • Cirrhosis, or the scarring of the liver – This occurs when scar tissue replaces healthy liver tissue. It is caused by long-term, recurrent liver damage.
  • Haemochromatosis – This is just one of many other systemic diseases that may affect the liver and the biliary tree.
  • Liver damage – Also known as hepatoxicity, it occurs when the liver is no longer able to function properly.
  • Fatty liver disease – The liver naturally has some fat content. However, if fat makes up more than 5 to 10 percent of the organ’s total weight, it is considered as fatty liver disease. It is caused by excessive alcohol consumption.
  • Hepatitis A, B, C, and E – Hepatitis is a disease that causes the liver to become inflamed. It is most commonly caused by a viral infection.
  • Pancreatitis – This is characterised by the inflammation of the pancreas. It can occur suddenly (acute) or develop over the course of time (chronic).
  • Liver cancer – Liver cancer is a disease wherein the liver becomes infected with malignant cells. It comes in two forms: primary liver cancer, wherein cancer begins in the liver, and liver metastasis or when cancer spreads to the liver from somewhere in the body.
  • Biliary atresia – A disease wherein the bile ducts are too narrow, are obstructed, or are completely absent. This can develop in infants at around two to eight weeks after birth. It is a life-threatening condition that has to be treated with surgery.


Liver problems may cause the following symptoms:

  • Gastrointestinal bleeding
  • Jaundice
  • Fever
  • Ascites or abdominal swelling due to fluid accumulation

    References:

  • Sabzi F, Faraji R. “Liver function tests following open cardiac surgery.” J Cardiovasc Thorac Res. 2015; 7(2): 49-54. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492177/

  • Ahmad NZ. “Routine testing of liver function before and after elective laparoscopic cholecystectomy: Is it necessary?” JSLS. 2011 Jan-Mar; 15(1): 65-69. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134700/