Definition and Scope of Hepatology
Hepatology is a division of internal medicine, specifically gastroenterology, that concerns the study, diagnosis, treatment, and prevention of diseases of the liver, gall bladder, pancreas, and biliary tree. A specialist in hepatology is called a hepatologist. A hepatologist is usually a gastroenterologist who has specialized in the field of hepatology; many are involved in treating and managing liver transplant patients.
Liver transplantation is a surgical procedure in which an injured or diseased liver is replaced with a whole or a portion of a healthy liver from a donor. The liver is the only organ in the body that can regenerate on its own. Hence, even if only a portion of liver is replaced, the organ will grow to a normal size. The procedure is performed in individuals with severe liver disease when the liver has stopped functioning normally.
Hepatology-Related Medical Specialties
Medical specialties related to hepatology include:
Hepatobiliary surgery
Transplant surgery
Gastroenterology
Critical Care Medicine
Infectious Disease
Pathology
Radiology
Surgical Oncology
Internal Medicine
Addiction Medicine
General Surgery
Family Medicine
Common Diseases and Medical Procedures
Common liver diseases seen in clinical practice are as follows:
Hepatocellular carcinoma (liver cancer): One of the most common types of cancer in adults. Early detection of liver cancer may be difficult, as initial symptoms of the disease can be nonspecific. Liver cirrhosis, as well as hepatitis B and C are the most common causes of primary liver cancer (tumor originating in the liver in primary cancer).
Liver cirrhosis: This is the end-stage of chronic (long-term) liver disease. In this condition, there is permanent scarring of liver tissue with poor liver function. The most common causes of cirrhosis are alcohol abuse (alcoholic liver disease), hepatitis B or C infection, and non-alcoholic fatty liver disease.
Non-alcoholic fatty liver disease (NAFLD): In this condition, there are excess fat deposits in the liver in the absence of alcohol abuse. Usually, there is no significant liver damage in patients with NAFLD. In advanced cases, inflammation and damaged liver cells are present. This stage of the disease is known as non-alcoholic steatohepatitis (NASH).
Portal hypertension: Increased pressure in the portal vein, which is the main vein of the liver. The most frequent cause of portal hypertension is liver cirrhosis.
Hepatitis: Irritation and inflammation of the liver due to infection caused by the viruses hepatitis A, B, C, D, and E. Hepatitis B and C infections increase the risk of liver cirrhosis and liver cancer.
Common medical procedures for liver diseases:
Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to diagnose and treat several biliary and pancreatic diseases.
Transhepatic pancreatocholangiography: An x-ray is used to detect obstruction in the bile ducts or the liver.
Transjugular intrahepatic portosystemic shunt: An artificial channel is made to form a connection between the portal and the hepatic veins.
Liver Transplantation: Liver transplant is recommended in patients whose liver has stopped functioning normally (liver failure). Different conditions can cause liver failure, which could be acute or chronic. Acute liver failure can happen in the case of sudden infections or toxic exposure (to medications or chemicals). Chronic liver failure is progressive and usually occurs because of existing liver or other diseases. Common conditions that can lead to liver failure include:
Chronic hepatitis C.
Cholangitis, which is inflammation of the biliary system. There are multiple causes of cholangitis. These include:
Long-term alcohol abuse
Chronic hepatitis B and C
Autoimmune hepatitis
Non-alcoholic steatohepatitis
Genetic diseases such Wilson’s disease (abnormally high levels of copper in the liver), hemochromatosis (iron build-up in the liver)
Bile duct diseases
Liver transplant uses donated livers which come from either of the two sources:
Deceased donor transplantation
Living donor transplantation
As with any transplant, liver transplantation raises autoimmune and rejection issues. Organ matching can take weeks or months or years, depending on availability of a suitable donor organ.
Hepatology Medical-Legal Cases
The liver is one of the most important organs in the human body. Negligence in the diagnosis, treatment, and monitoring of a liver disease can have serious, sometimes fatal, consequences. Hepatology issues more often involve the causation/damages flowing from alleged deviation by other specialists and by primary care physicians. Cases involving exposure to chemicals or overmedication typically require a toxicologist as well.
Failure to diagnose a liver condition:
Liver cancer: Failure to diagnose primary liver cancer (commonly hepatocellular cancer [HCC] or adenocarcinoma) or the metastases of other cancers (e.g., colon) may result in litigation. Whether the patient already has another type of cancer or a family history may be relevant.
Hepatitis: All types of hepatitis can lead to serious liver diseases. Failure to diagnose hepatitis infection can cause progressive liver damage.
Negligence in providing treatment for a liver disease.
Negligence in monitoring treatment of a liver disease.
Omitting genetic testing in patients at high-risk of liver cancer or genetic liver diseases.
Miscalculation in chemotherapeutic dosage for liver cancer treatment.
Injury caused by procedures such as ERCP.
Medical malpractice in liver transplantation include:
Failure to attempt conservative treatment before resorting to transplant.
Failure to match organs correctly causing organ rejection
Death of a patient due to surgical error