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 2 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, though, 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 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 gall stone
Cancer of above organs.
Usually multi-disciplinary approach is undertaken with involvement of oncologist and other experts.
History
Evidence from autopsies on Egyptian mummies suggest that liver damage from parasitic infection
Bilharziasis was widespread in the ancient society.
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.
In 400 BC Hippocrates mentioned liver abscess in Aphorisms.
Roman anatomist Galen thought the liver was the principal organ of the body.
He also identified its relationship with the gallbladder and spleen.
Around 100CE Areteus of cappadoca wrote on jaundice
In medieval period Avicenna noted the importance of urine in diagnosing liver conditions.
1770 French anatomist Antoine Portal noted bleeding due to oesophageal varices,
1844 Gabriel Valentin showed pancreatic juices break down food in digestion.
1846 Justus Von Leibig discovered pancreatic juice tyrosine
1862 Austin Flint described the production of "stercorin".
1875 Victor Charles Hanot described cirrhotic jaundice and other diseases of liver
In 1958, Moore developed a standard technique for canine orthotopic liver transplantation.
The first human liver transplant was performed in 1963 by Dr. Thomas E. Starzl on a 3-year-old
male afflicted with biliary atresia after perfecting the technique on canine livers.,
Baruch S. Blumberg discovered Hepatitis B virus in 1966 and developed first vaccine
against it 1969.
He was awarded the Nobel Prize in Physiology or Medicine 1976.
In 1989, investigators from the CDC and Chiron 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.
Only in 1992 was a blood test created that could detect hepatitis C in donated blood.
The word hepatology is from Ancient Greek ἧπαρ or ἡπατο-, meaning "liver",
and -λογία, meaning "study".
Disease classification 1.
International Classification of Disease/ WHO classification:
Chapter XI: Diseases of the digestive system [1]
K70-K77 Diseases of liver K80-K87 Disorders of gallbladder, biliary
tract and pancreas
2.
MeSH: G02.403.776.409.405 same as "Gastroenterology"
C06.552 Liver Diseases C06.130 Biliary Tract Diseases
C06.689 Pancreatic diseases 3.National Library of Medicine Catalogue:
WI 700-740 Liver and biliary tree Diseases WI 800-830 Pancrease
Also see Hepato-biliary diseases Important procedures
Endoscopic retrograde cholangiopancreatography(ERCP) Transhepatic pancreato-cholangiography(TPC)
Transjugular intrahepatic portosystemic shunt(TIPSS) References