Hepatology is the branch of

medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

that incorporates the study of

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow Organ (anatomy), organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath t ...

biliary tree The biliary tract (also biliary tree or biliary system) refers to the liver, gallbladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids a ...

, and

pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...

as well as management of their disorders. Although traditionally considered a sub-specialty of

gastroenterology Gastroenterology (from the Greek gastḗr- "belly", -énteron "intestine", and -logía "study of") is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometime ...

, 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 Hepatitis B is an infectious disease caused by the '' hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. ...

virus at some point in their life, and approximately 350 million have become persistent carriers. Up to 80% of

liver cancer Liver cancer, also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy, is cancer that starts in the liver. Liver cancer can be primary in which the cancer starts in the liver, or it can be liver metastasis, or secondar ...

s can be attributed to either hepatitis B or

hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include ...

virus. In terms of mortality, the former is second only to smoking among known agents causing

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

. With more widespread implementation of

vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...

and strict

screening Screening may refer to: * Screening cultures, a type a medical test that is done to find an infection * Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees) * Screening (environmental), a s ...

before

blood transfusion Blood transfusion is the process of transferring blood products into a person's Circulatory system, circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used ...

, lower

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

rates are expected in the future. In many countries, however, overall alcohol consumption is increasing, and consequently the number of people with

cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, chronic liver failure or chronic hepatic failure and end-stage liver disease, is a chronic condition of the liver in which the normal functioning tissue, or parenchyma, is replaced ...

and other related complications is commensurately increasing. Hepato-biliary

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 Paracetamol poisoning, also known as acetaminophen poisoning, is caused by excessive use of the medication paracetamol (acetaminophen). Most people have few or non-specific symptoms in the first 24 hours following overdose. These symptom ...

is common. *

Gastrointestinal bleeding Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may includ ...

from

portal hypertension Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5� ...

related to liver damage * Abnormal blood test suggesting

liver disease Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common. Liver diseases File:Ground gla ...

Enzyme An enzyme () is a protein that acts as a biological catalyst by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates into different mol ...

defects leading to bigger liver in children commonly named storage disease of liver *

Jaundice Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving ...

Hepatitis Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...

virus positivity in blood, perhaps discovered on screening blood tests *

Ascites Ascites (; , meaning "bag" or "sac") is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdo ...

or swelling of

abdomen The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...

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 Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is primarily performed by highly skill ...

for diagnosing diseases of biliary tree or their management *

Fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

with other features suggestive of infection involving mentioned organs. Some exotic

tropical The tropics are the regions of Earth surrounding the equator, where the sun may shine directly overhead. This contrasts with the temperate or polar regions of Earth, where the Sun can never be directly overhead. This is because of Earth's ax ...

diseases like

hydatid cyst Echinococcosis is a parasitic disease caused by tapeworms of the ''Echinococcus'' type. The two main types of the disease are ''cystic echinococcosis'' and '' alveolar echinococcosis''. Less common forms include ''polycystic echinococcosis'' a ...

kala-azar Visceral leishmaniasis (VL), also known as kala-azar (Hindi: kālā āzār, "black sickness") or "black fever", is the most severe form of leishmaniasis and, without proper diagnosis and treatment, is associated with high fatality. Leishmaniasi ...

schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever is a neglected tropical helminthiasis, disease caused by parasitism, parasitic Schistosoma, flatworms called schistosomes. It affects both humans and animals. It affects ...

may be suspected.

Microbiologists A microbiologist (from Greek ) is a scientist who studies microscopic life forms and processes. This includes study of the growth, interactions and characteristics of microscopic organisms such as bacteria, algae, fungi, and some types of paras ...

would be involved as well * Systemic diseases affecting liver and biliary tree e.g.

haemochromatosis Iron overload is the abnormal and increased accumulation of total iron in the body, leading to organ damage. The primary mechanism of organ damage is oxidative stress, as elevated intracellular iron levels increase free radical formation via the ...

* Follow-up of

liver transplant Liver transplantation or hepatic transplantation is the replacement of a Liver disease, diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for Cirrhosis, end-stage liver disease and ...

Pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormone A hormone (from the Ancient Greek, Greek participle , "se ...

- commonly due to alcohol or

gallstone A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of ...

* Cancer of above organs. Usually multi-disciplinary approach is undertaken with involvement of

oncologist Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''� ...

and other experts.

History

Evidence from autopsies on Egyptian

mummies A mummy is a dead human or an animal whose soft tissues and Organ (biology), organs have been preserved by either intentional or accidental exposure to Chemical substance, chemicals, extreme cold, very low humidity, or lack of air, so that the ...

suggests that liver damage from the

parasitic Parasitism is a close relationship between species, where one organism, the parasite, lives (at least some of the time) on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The ent ...

infection

bilharziasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever is a neglected tropical disease caused by parasitic flatworms called schistosomes. It affects both humans and animals. It affects the urinary tract or the intestines. Sy ...

was widespread in the ancient society. It is possible that the

Greeks Greeks or Hellenes (; , ) are an ethnic group and nation native to Greece, Greek Cypriots, Cyprus, Greeks in Albania, southern Albania, Greeks in Turkey#History, Anatolia, parts of Greeks in Italy, Italy and Egyptian Greeks, Egypt, and to a l ...

may have been aware of the liver's ability to exponentially duplicate as illustrated by the story of

Prometheus In Greek mythology, Prometheus (; , , possibly meaning "forethought")Smith"Prometheus". is a Titans, Titan. He is best known for defying the Olympian gods by taking theft of fire, fire from them and giving it to humanity in the form of technol ...

. However, knowledge about liver disease in

antiquity Antiquity or Antiquities may refer to: Historical objects or periods Artifacts *Antiquities, objects or artifacts surviving from ancient cultures Eras Any period before the European Middle Ages (5th to 15th centuries) but still within the histo ...

is questionable. Most of the important advances in the field have been made in the last 50 years. * In 400 BC

Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...

mentioned

liver abscess A liver abscess is a mass filled with pus inside the liver. Common causes are abdominal conditions such as appendicitis or diverticulitis due to haematogenous spread through the portal vein. It can also develop as a complication of a liver injury. ...

aphorisms An aphorism (from Greek ἀφορισμός: ''aphorismos'', denoting 'delimitation', 'distinction', and 'definition') is a concise, terse, laconic, or memorable expression of a general truth or principle. Aphorisms are often handed down by tra ...

. *

Roman Roman or Romans most often refers to: *Rome, the capital city of Italy *Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of Roman civilization *Epistle to the Romans, shortened to Romans, a letter w ...

anatomist Anatomy () is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old scien ...

Galen Aelius Galenus or Claudius Galenus (; September 129 – AD), often Anglicization, anglicized as Galen () or Galen of Pergamon, was a Ancient Rome, Roman and Greeks, Greek physician, surgeon, and Philosophy, philosopher. Considered to be one o ...

thought the liver was the principal organ of the body. He also identified its relationship with the gallbladder and spleen. * Around 100 CE

Aretaeus of Cappadocia Aretaeus () is one of the most celebrated of the ancient Greek physicians. Little is known of his life. He was ethnically Greek, born in the Roman province of Cappadocia, Asia Minor (modern day Turkey), and most likely lived in the second half o ...

wrote on jaundice * In the medieval period

Avicenna Ibn Sina ( – 22 June 1037), commonly known in the West as Avicenna ( ), was a preeminent philosopher and physician of the Muslim world, flourishing during the Islamic Golden Age, serving in the courts of various Iranian peoples, Iranian ...

noted the importance of urine in diagnosing liver conditions. * In 1770, French anatomist

Antoine Portal Baron Antoine Portal (January 5, 1742 – July 23, 1832) was a French anatomist, medical doctor, medical historian and founding president of the Académie Nationale de Médecine. Biography Born on January 5, 1742, in Gaillac, he was the eldest ...

noted bleeding due to

oesophageal varices Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop ...

, * In 1844, Gabriel Valentin showed pancreatic juices break down food in digestion. * 1846 Justus Von Leibig discovered

pancreatic juice Pancreatic juice is a liquid secreted by the pancreas, which contains a number of digestive enzymes, including trypsinogen, chymotrypsinogen, elastase, carboxypeptidase, pancreatic lipase, nucleases and amylase. The pancreas is located in th ...

tyrosine -Tyrosine or tyrosine (symbol Tyr or Y) or 4-hydroxyphenylalanine is one of the 20 standard amino acids that are used by cells to synthesize proteins. It is a conditionally essential amino acid with a polar side group. The word "tyrosine" is ...

* 1862

Austin Flint Austin Flint I (October 20, 1812 – March 13, 1886) was an American physician. He was a founder of Buffalo Medical College, precursor to The State University of New York at Buffalo. He served as president of the American Medical Association. ...

described the production of "stercorin". * 1875 Victor Charles Hanot described cirrhotic jaundice and other diseases of the liver * In 1958, Moore developed a standard technique for

canine Canine may refer to: Zoology and anatomy * Animals of the family Canidae, more specifically the subfamily Caninae, which includes dogs, wolves, foxes, jackals and coyotes ** ''Canis'', a genus that includes dogs, wolves, coyotes, and jackals ** Do ...

orthotopic Orthotopic procedures (from Greek Greek may refer to: Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group *Greek language, a branch of the Indo-European language family **Proto-Greek language, the assu ...

liver transplantation Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure, al ...

. * The first human liver transplant was performed in 1963 by Dr. Thomas E. Starzl on a three-year-old male afflicted with

biliary atresia Biliary atresia, also known as extrahepatic ductopenia and progressive obliterative cholangiopathy, is a childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent. It can be congenital or acquired. ...

after perfecting the technique on canine livers. * 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 The Nobel Prize in Physiology or Medicine () is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, acco ...

1976. * In 1989, investigators from the CDC ( Daniel W. Bradley) and Chiron (

Michael Houghton Sir Michael Houghton (born 1949) is a British scientist and Nobel Prize laureate. Along with Qui-Lim Choo, George Kuo and Daniel W. Bradley, he co-discovered Hepatitis C in 1989. He also co-discovered the Hepatitis D genome in 1986. The discove ...

) 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 Ancient Greek (, ; ) includes the forms of the Greek language used in ancient Greece and the classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Greek ...

ἧπαρ (''hepar'') or ἡπατο- (''hepato-''), meaning "liver", and -λογία (''-logia''), meaning "study".

Disease classification

1. International Classification of Disease ( ICD 2007) – WHO classification: * Chapter XI: Diseases of the digestive system ** 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"'' * 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 Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior ...

(ERCP) *

Transhepatic pancreato-cholangiography Percutaneous transhepatic cholangiography, percutaneous hepatic cholangiogram (PTHC) is a radiological technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays a ...

(TPC) *

Transjugular intrahepatic portosystemic shunt Transjugular intrahepatic portosystemic shunt (TIPS or TIPSS) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension (which is ...

( TIPSS) *

Liver transplant Liver transplantation or hepatic transplantation is the replacement of a Liver disease, diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for Cirrhosis, end-stage liver disease and ...

and

pancreas transplant A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes. Overview Because the pancreas is a vital organ, performing functions necessary in the ...

References

{{Authority control Gastroenterology

Scope of specialty

History

Disease classification

Important procedures

See Also

References