HEPATOLOGY

Hepatology

Hepatology is an area of medicine that focuses on diseases of the liver as well as related conditions.
A hepatologist is a specialized doctor involved in the diagnosis and treatment of hepatic diseases, which include issues that affect your:
❖ liver
❖ gallbladder
❖ pancreas
❖ biliary tract
Here’s what you need to know if you’re considering seeing a hepatologist for diagnosis or management of a related medical condition and are seeking to obtain a referral to this type of specialist.

What is hepatology?
Hepatology is distinct from other specialized forms of medicine because of its focus on organs affected by hepatic diseases. Your hepatic system includes the following organs.

Liver
Hepatology’s primary focus is on the liver.
This essential organ is responsible for helping to digest the foods you eat as well as supporting your metabolism and getting rid of toxins.
The liver also helps store and process fat-soluble vitamins, such as vitamin D3 and vitamin E.

Pancreas
Located behind the stomach, the pancreas is responsible for making insulin and producing digestive enzymes.
Acute or chronic pancreatitis can occur when the enzymes involved in digestion damage the pancreas, causing serious inflammation.
This can also happen when the digestive enzymes made by the liver or pancreas can’t be released due to a blockage by a stone

Gallbladder
The gallbladder is a small organ located on the upper-right part of your stomach.
The gallbladder is a pouch that collects the bile produced by the liver. When you eat a meal, it contracts and dumps its contents into the intestines to help with digestion.
Gallstones can form when bile imbalances occur, thereby blocking bile flow.

Biliary tract
Also called the biliary tree or biliary system, the biliary tract is the connection, or tract, between the liver, the gallbladder, and the pancreas.
The biliary tract allows bile and pancreatic enzymes to get into the small intestine to help with digestion, including fat digestion.

What is a hepatologist?
Hepatologists are doctors who specialize in the field of hepatic diseases and the organs that these conditions affect. Their goal is to help diagnose and treat hepatic conditions, such as hepatitis, fatty liver disease, pancreatitis, and more.
While hepatology is not a board certified specialty according to the American Board of Medical Specialties (ABMS), it’s generally considered a subspecialty of gastroenterology. It’s only been more recently regarded as separate from gastroenterology in the last few decades.
As such, doctors who are trained in hepatology are also certified in both internal medicine and gastroenterology first.

What conditions do hepatologists treat?
Hepatologists primarily treat liver diseases, including:
❖ hepatitis infections
❖  fatty liver disease, both alcohol-related and not
❖ jaundice
❖ cirrhosis
❖ metabolic liver diseases
❖ liver cancer
Additionally, a hepatologist may help treat other conditions that impact the hepatic system, such as:
❖ pancreatitis
❖ pancreatic cancer
❖ gallstones
❖ gallbladder cancer
❖ gallbladder inflammation (cholecystitis)
❖ bile duct stones (choledocholithiasis)
❖ bile duct adenomas (noncancerous tumors)
❖ bile duct cancer
Some hepatologists may be able to diagnose cancer, but they’ll most likely make a referral to an oncologist for further treatment of cancer.

What procedures do hepatologists perform?
Hepatologists perform a wide range of procedures that help diagnose or treat conditions that affect your hepatic system.

Procedures performed by hepatologists
❖  blood testing to detect signs of infections, such as gallstones and pancreatitis, and inflammation of hepatic organs
❖ imaging tests, such as ultrasounds, to identify gallstones, cysts, and tumors
❖ cholescintigraphy scans that use small amounts of radioactive material to help take pictures of the biliary tract
❖ endoscopies performed via long tubes with cameras to help provide images of your hepatic system to get a better look at your gallbladder and bile ducts
❖ hepatobiliary iminodiacetic acid (HIDA) scans to monitor bile production
❖ biopsies of cysts, tumors, or other suspicious growths on your hepatic organs

When should I see a hepatologist?
It’s important to meet with your doctor right away if you have the following possible signs of a hepatic condition:
❖ persistent abdominal pain
❖ abdominal swelling
❖ chronic fatigue
❖ loss of appetite
❖ unintentional weight loss
❖ dark or bloody urine
❖ bloody, pale, or dark stools
❖ chronic diarrhea
❖ nausea
❖ vomiting
❖ yellowing of the skin or eyes (jaundice)
❖ increased heart rate
❖ low-grade fever, with or without chills
❖ leg or ankle swelling
Typically, you’ll need a referral from your primary care doctor in order to see a hepatologist. Results from a physical exam and blood testing can warrant a referral to a hepatologist.
Your doctor may refer you based on some of the symptoms you’re experiencing as well as your medical history or individual risk factors for hepatic conditions.
You may need to see a hepatologist for these symptoms if you have a personal or family history of hepatic conditions. For example, you may be at an increased riskTrusted Source of pancreatitis if you’ve previously had gallstones.
Your doctor may recommend regular screenings if you’re over age 50 or if you:
❖ a history of alcohol use disorder
❖ obesity
❖ noticed recent, significant weight loss
❖ personal or family history of any hepatic conditions
❖ diabetes
❖ high cholesterol
❖ high triglycerides
❖ Crohn’s disease
❖ metabolic syndrome

How are hepatology and gastroenterology connected?
Hepatology is linked to gastroenterology because it involves parts of the gastrointestinal (GI) tract.
Like the hepatic system, the GI tract includes the liver, pancreas, and gallbladder. It also includes the:
❖ esophagus
❖ intestines
❖ rectum
❖ other parts of the body involved with digestion
Hepatology is sometimes considered a branch of gastroenterology because both specialties encompass some of the same organs. A gastroenterologist can help diagnose and treat similar conditions, but a hepatologist’s focus is narrower.
Based on your current symptoms and overall health history, your primary care doctor can help you decide whether you can benefit more from a general gastroenterologist or a hepatologist.
It’s also possible to see an internal medicine doctor who specializes in these diseases.