Hepatology
Encyclopedia
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
that incorporates the study of liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, gallbladder
Gallbladder
In vertebrates the gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated....
, biliary tree
Biliary tree
The biliary tract is the common anatomical term for the path by which bile is secreted by the liver then transported to the first part of the small intestine, also known as the duodenum...
, and pancreas
Pancreas
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
as well as management of their disorders. Etymologically the word Hepatology is formed of ancient Greek
Ancient Greek
Ancient Greek is the stage of the Greek language in the periods spanning the times c. 9th–6th centuries BC, , c. 5th–4th centuries BC , and the c. 3rd century BC – 6th century AD of ancient Greece and the ancient world; being predated in the 2nd millennium BC by Mycenaean Greek...
hepar(ηπαρ) or hepato-(ηπατο-) meaning ' liver' and suffix -logia(-λογια) meaning 'word' or 'speech'. Although traditionally considered a sub-specialty of gastroenterology
Gastroenterology
Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster , enteron , and logos...
, 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
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E...
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 cancer
Liver cancer
Liver tumors or hepatic tumors are tumors or growths on or in the liver . Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. These growths can be benign or malignant...
s can be attributed to either hepatitis B or Hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
virus. In terms of mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
, the former is second only to smoking among known agents causing cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
. With more widespread implementation of vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
and strict screening
Screening (medicine)
Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease....
before blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
, lower infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
rates are expected in the future. In many countries, though, overall alcohol consumption is increasing, and consequently the number of people with cirrhosis
Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...
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 ( i.e. GP) or by doctors from different disciplines. The reasons might be:- Drug overdose. Paracetamol overdose is common.
- Gastrointestinal bleedingGastrointestinal bleedingGastrointestinal bleeding or gastrointestinal hemorrhage describes every form of hemorrhage in the gastrointestinal tract, from the pharynx to the rectum. It has diverse causes, and a medical history, as well as physical examination, generally distinguishes between the main forms...
from portal hypertensionPortal hypertensionIn medicine, portal hypertension is hypertension in the portal vein and its tributaries.It is often defined as a portal pressure gradient of 10 mmHg or greater.-Causes:Causes can be divided into prehepatic, intrahepatic, and posthepatic...
related to liver damage - Abnormal blood test suggesting liver diseaseLiver diseaseLiver disease is a broad term describing any single number of diseases affecting the liver.-Diseases:* Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons , autoimmunity or hereditary conditions...
- EnzymeEnzymeEnzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
defects leading to bigger liver in children commonly named storage disease of liver - JaundiceJaundiceJaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...
/ HepatitisHepatitisHepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
virus positivity in blood, perhaps discovered on screening blood tests - AscitesAscitesAscites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...
or swelling of abdomenAbdomenIn vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
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
- FeverFeverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
with other features suggestive of infection involving mentioned organs. Some exotic tropical diseases like hydatid cyst, kala-azar or schistosomiasisSchistosomiasisSchistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...
may be suspected. Microbiologists would be involved as well - Systemic diseases affecting liver and biliary tree e.g. haemochromatosisHaemochromatosisHaemochromatosis type 1 is a hereditary disease characterized by excessive intestinal absorption of dietary iron resulting in a pathological increase in total body iron stores. Humans, like most animals, have no means to excrete excess iron...
- Follow up of liver transplant
- PancreatitisPancreatitisPancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...
- commonly due to alcohol or gall stone - Cancer of above organs. Usually multi-disciplinary approach is under taken with involvement of oncologist and other experts.
History
It is possible that the Greeks
Greeks
The Greeks, also known as the Hellenes , are a nation and ethnic group native to Greece, Cyprus and neighboring regions. They also form a significant diaspora, with Greek communities established around the world....
may have been aware of the liver's ability to exponentially duplicate as illustrated by the story of Prometheus
Prometheus
In Greek mythology, Prometheus is a Titan, the son of Iapetus and Themis, and brother to Atlas, Epimetheus and Menoetius. He was a champion of mankind, known for his wily intelligence, who stole fire from Zeus and gave it to mortals...
. However, knowledge about liver disease in antiquity
Classical antiquity
Classical antiquity is a broad term for a long period of cultural history centered on the Mediterranean Sea, comprising the interlocking civilizations of ancient Greece and ancient Rome, collectively known as the Greco-Roman world...
is questionable. Most of the important advances in the field have been made in the last 50 years.
- In 400 BC HippocratesHippocratesHippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
mentioned liver abscessLiver abscessA liver abscess is a pus-filled mass inside the liver. Common causes are abdominal infections such as appendicitis or diverticulitis due to haematogenous spread through the portal vein...
in apporium. - RomanAncient RomeAncient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....
anatomist GalenGalenAelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
thought the liver was the principle 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 AvicennaAvicennaAbū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...
noted the importance of urine in diagnosing liver conditions. - 1770 French anatomist Antoine PortalAntoine PortalBaron Antoine Portal was a French anatomist, doctor, medical historian and founding president of the Académie Nationale de Médecine. Born on January 5 1742 in Gaillac, he was the eldest of 12 siblings...
noted bleeding due to oesophageal varices, - 1844 Gabriel Valentin showed pancreatic juices break down food in digestion.
- 1846 Justus Von Leibig discovered pancreatic juicePancreatic juicePancreatic juice is a liquid secreted by the pancreas, which contains a variety of enzymes, including trypsinogen, chymotrypsinogen, elastase, carboxypeptidase, pancreatic lipase, and amylase....
tyrosineTyrosineTyrosine or 4-hydroxyphenylalanine, is one of the 22 amino acids that are used by cells to synthesize proteins. Its codons are UAC and UAU. It is a non-essential amino acid with a polar side group... - 1862 Austin FlintAustin Flint, 2ndAustin Flint was an American physician, born at Northampton, Massachusetts, son of Austin Flint. He attended medical lectures at the University of Louisville from 1854 to 1856 and in 1856 and 1857 at Jefferson Medical College, Philadelphia...
described the production of "stercorin"CoprosterolCoprosterol is the odorous principle of feces. American physician Austin Flint named it stercorin. It is also generally called coprostanol, especially in reference to its effects on the environment....
. - 1875 Victor Charles HanotVictor Charles HanotVictor Charles Hanot 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. Also, he was professor agrégé of general medicine in Paris, and editor-in-chief of the Archives...
described cirrhotic jaundice and other diseases of liver - In 1958, Moore developed a standard technique for canineCanidaeCanidae is the biological family of carnivorous and omnivorous mammals that includes wolves, foxes, jackals, coyotes, and domestic dogs. A member of this family is called a canid . The Canidae family is divided into two tribes: Canini and Vulpini...
orthotopic liver transplantationLiver transplantationLiver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original...
. - The first human liver transplant was performed in 1963 by Dr. Thomas E. StarzlThomas StarzlThomas E. Starzl is an American physician, researcher, and is an expert on organ transplants. He performed the first human liver transplants, and has often been referred to as "the father of modern transplantation."-Life:...
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 MedicineNobel Prize in Physiology or MedicineThe Nobel Prize in Physiology or Medicine administered by the Nobel Foundation, is awarded once a year for outstanding discoveries in the field of life science and medicine. It is one of five Nobel Prizes established in 1895 by Swedish chemist Alfred Nobel, the inventor of dynamite, in his will...
1976.
Disease classification
1. International Classification of DiseaseICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
(ICD 2007)/ WHO classification
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
:
- Chapter XI: Diseases of the digestive systemICD-10 Chapter XI: Diseases of the digestive system- Diseases of oral cavity, salivary glands and jaws :* Disorders of tooth development and eruption** Anodontia***Hypodontia***Oligodontia** Supernumerary teeth** Abnormalities of size and form of teeth***Concrescence***Tooth fusion...
http://www.who.int/classifications/apps/icd/icd10online/- K70-K77 Diseases of liver
- K80-K87 Disorders of gallbladder, biliary tract and pancreas
2. MeSH (medical subject heading)
Medical Subject Headings
Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching...
:
- 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 (NLM classification 2007):
Also see Hepato-biliary diseases
Hepato-biliary diseases
Hepato-biliary diseases affect the liver and/or biliary tract, and are studied in the branch of medicine called Hepatology.-Viral hepatitis:* Acute hepatitis A* Acute hepatitis B...
Important procedures
- Endoscopic retrograde cholangiopancreatographyEndoscopic retrograde cholangiopancreatographyEndoscopic retrograde cholangiopancreatography is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems...
(ERCP) - Transhepatic pancreato-cholangiography(TPC)
- Transjugular intrahepatic portosystemic shuntTransjugular intrahepatic portosystemic shuntA Transjugular Intrahepatic Portosystemic Shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein...
(TIPSS)
Publication
- Annals of Gastroenterology & Hepatology (AGH)
- The American Journal of Gastroenterology (Journal of the American College of Gastroenterology)
- The American Journal of Physiology - Gastrointestinal and Liver Physiology
- Archives of Gastroenterohepatology
- Comparative Hepatology
- Current Hepatitis Reports
- European Journal of Gastroenterology and Hepatology
- Gastroenterología y Hepatología
- Gastroenterology (journal of the American Gastroenterological Association)
- Hepatobiliary & pancreatic diseases international : HBPD INT (First Affiliated Hospital, Zhejiang University School of Medicine, China)
- Hepatology (journal of the American Association for the Study of Liver Diseases)
- HPB
- Journal of Gastroenterology and Hepatology
- HPB Surgery
- Journal of Hepato-Biliary-Pancreatic Surgery
- Journal of Hepatology (journal of the European Association for the Study of Liver Diseases)
- Journal of Viral Hepatitis
- Liver
- Liver Transplantation (from the American Association for the Study of Liver Diseases)
- Nature clinical practice. Gastroenterology & hepatology.
Societies
- American Association for the Study of Liver Disease
- American College of Gastroenterology
- American Gastroenterological Association
- American Hepato-Pancreato-Biliary Association
- American Liver Society
- Asian Pacific Association for the Study of the Liver
- Austrian Society of Gastroenterology and Hepatology
- British Association for the Study of the Liver
- British Society of Paediatric Gastroenterology, Hepatology and Nutrition
- Canadian Association for the Study of the Liver
- Canadian Liver Foundation
Czech Society of Hepatology
- Danish Association for the Study of the Liver
- European Association for the Study of the Liver
- European Society of Paediatric Gastroenterology, Hepatology and Nutrition
- French Association for the Study of the Liver
- International Hepato-Pancreato-Biliary Association
- International Liver Transplantation Society
- Israel Association for the Study of the Liver
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
- Society for Surgery of the Alimentary Tract
- Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition
- Swiss Association for the Study of the Liver
- Turkish Association for the Study of the Liver