Hepatology is the branch of

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

that incorporates the study of

liver The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...

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

biliary tree The biliary tract, (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 and co ...

, and

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an end ...

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 ...

, 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 Viral hepatitis is liver inflammation due to a viral infection. It may present in acute form as a recent infection with relatively rapid onset, or in chronic form. The most common causes of viral hepatitis are the five unrelated hepatotropic v ...

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. Fo ...

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 (starts in liver) or secondary (meaning cancer which has spread from elsewhere to th ...

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 people often have mild or no symptoms. Occasionally a fever, dark urine, a ...

virus. In terms of

mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

, the former is second only to smoking among known agents causing

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

. 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 ...

before

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

, lower

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

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, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...

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 include ...

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 incl ...

from

portal hypertension Portal hypertension is abnormally increased portal venous pressure – blood pressure in the portal vein and its branches, that drain from most of the intestine to the liver. Portal hypertension is defined as a hepatic venous pressure gradient gr ...

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. Signs and symptoms Some of the sig ...

Enzyme Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrates, and the enzyme converts the substrates into different molecules known as products. A ...

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

Jaundice Jaundice, also known as icterus, is a yellowish or 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 abnormal heme meta ...

Hepatitis Hepatitis is inflammation of the 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), poor appetite, vomiting, tiredness, abdominal pa ...

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

Ascites Ascites 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 abdominal size, increased weight, ab ...

or swelling of

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

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 skille ...

for diagnosing diseases of biliary tree or their management *

Fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...

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

tropical The tropics are the regions of Earth surrounding the Equator. They are defined in latitude by the Tropic of Cancer in the Northern Hemisphere at N and the Tropic of Capricorn in the Southern Hemisphere at S. The tropics are also referred to ...

diseases like

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

, kala-azar or

schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody s ...

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 para ...

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

haemochromatosis Iron overload or hemochromatosis (also spelled ''haemochromatosis'' in British English) indicates increased total accumulation of iron in the body from any cause and resulting organ damage. The most important causes are hereditary haemochromatos ...

* 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 hormones. There are two main types: acute pancreatitis, and chronic pancr ...

- commonly due to alcohol or

gallstone A gallstone is a calculus (medicine), 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 ...

* 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 (''ó ...

and other experts.

History

Evidence from autopsies on Egyptian

mummies A mummy is a dead human or an animal whose soft tissues and organs have been preserved by either intentional or accidental exposure to chemicals, extreme cold, very low humidity, or lack of air, so that the recovered body does not decay furth ...

suggests that liver damage from the

parasitic Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson has c ...

infection

bilharziasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody ...

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

Greeks The Greeks or Hellenes (; el, Έλληνες, ''Éllines'' ) are an ethnic group and nation indigenous to the Eastern Mediterranean and the Black Sea regions, namely Greece, Cyprus, Albania, Italy, Turkey, Egypt, and, to a lesser extent, oth ...

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 Titan god of fire. Prometheus is best known for defying the gods by stealing fire from them and giving it to humanity in the form of technology, know ...

. 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 Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...

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 Ancient Greek, 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 hand ...

. *

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 ancient Rome *''Epistle to the Romans'', shortened to ''Romans'', a letter ...

anatomist Anatomy () is the branch of biology concerned with the study of the 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 science, having its ...

Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...

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 ( grc-gre, Ἀρεταῖος) is one of the most celebrated of the ancient Greek physicians. Little is known of his life. He presumably was a native or at least a citizen of Cappadocia (Roman province), Cappadocia, a Roman province in ...

wrote on jaundice * In the medieval period

Avicenna Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic G ...

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

, * 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 the v ...

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 non-essential amino acid with a polar side group. The word "tyrosine" is from the Gr ...

* 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 Victor Charles Hanot (6 July 1844 – 28 October 1896) was a French physician remembered for his work in the field of hepatology. He earned his medical doctorate in 1875, and was associated with the Hôpital Saint-Antoine in Paris. He was ''profe ...

described cirrhotic jaundice and other diseases of the liver * In 1958, Moore developed a standard technique for canine

orthotopic Orthotopic procedures (from Greek ''orthos'', straight + ''topos'', place) are those occurring at the normal place. Examples include: * Orthotopic liver transplantation, in which the previous liver is removed and the transplant is placed at that lo ...

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 Thomas Earl Starzl (March 11, 1926 – March 4, 2017) was an Health care in the United States, American physician, Medical research, researcher, and expert on organ transplants. He performed the first human liver transplants, and has often been ...

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. I ...

after perfecting the technique on canine livers. *

Baruch S. Blumberg Baruch Samuel Blumberg (July 28, 1925 April 5, 2011), known as Barry Blumberg, was an American physician, geneticist, and co-recipient of the 1976 Nobel Prize in Physiology or Medicine (with Daniel Carleton Gajdusek), for his work on the hepat ...

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, accord ...

1976. * In 1989, investigators from the CDC (

Daniel W. Bradley Daniel W. Bradley (born 13 July 1941) is an important American virologist who, along with Michael Houghton, Qui-Lim Choo and George Kuo at Chiron Corporation, worked to help isolate the Hepatitis C virus in 1989. He graduated from San José Stat ...

) and Chiron ( Michael Houghton) 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 ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...

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

Disease classification

International Classification of Disease The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinatin ...

( 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 and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is primarily performed by highly skille ...

(ERCP) * Transhepatic pancreato-cholangiography (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