Hepatology
Hepatology is a specialized branch of medicine focused on the liver and associated systems, such as the gallbladder and pancreas. It encompasses the study, diagnosis, treatment, and prevention of liver diseases and disorders, which can have significant implications for metabolism and toxin elimination in the body. Hepatologists, the medical professionals in this field, not only treat conditions like hepatitis, liver cancer, and cirrhosis, but also engage in research aimed at improving diagnostic and management techniques. Historically, hepatology was considered a sub-specialty of gastroenterology, but it has since gained recognition as an independent discipline. The field is notably influenced by pioneering figures such as Shiela Sherlock, who contributed foundational knowledge and established important clinical research centers. Liver transplants are a critical area of hepatology, addressing the needs of patients with liver failure. Hepatologists also perform various diagnostic procedures, including endoscopic retrograde cholangiopancreatography and transhepatic pancreato-cholangiography. Major journals like Hepatology and the Journal of Hepatology contribute to ongoing advancements and research dissemination within the field.
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Hepatology
Hepatology is a specialized branch of medicine focused on the study, diagnosis, treatment, and prevention of diseases, disorders, and health issues associated with the liver. The term is an amalgamation of two Greek words: hepatikos, which means "liver," and logia, which means "study." The field of hepatology also includes adjacent and related bodily systems, including the gallbladder, pancreas, and biliary tree.
Doctors who specialize in the field of hepatology are known as hepatologists. In addition to diagnosing and treating patients with liver-related diseases and conditions, hepatologists also perform research and investigate new diagnostic and disease management methods. Hepatology was formerly considered a sub-speciality of gastroenterology, the branch of medicine focused on diseases and disorders of the digestive system. Only recently has hepatology emerged as a distinct area of specialization.
Background
The Anglo-Irish physician Shiela Sherlock (1918–2001) often is referred to as "the mother of hepatology" for her groundbreaking work in the field, which began in the middle of the twentieth century. In 1955, Sherlock published Diseases of the Liver and Biliary System, which became a standard textbook in medical schools around the world and is recognized as hepatology's first dedicated work. Four years later, Sherlock became the first woman ever to hold a professorship at London's Royal Free Hospital. At the hospital, she established a clinical research center for the study of liver-related diseases, where many future leaders of the emerging field of hepatology undertook their training.
Although Sherlock successfully established liver-related diseases and conditions as a specialized branch of medicine, hepatology initially was classified as part of gastroenterology. The field of gastroenterology covers diseases and disorders of the esophagus, stomach, intestines, colon, rectum, bile ducts, gallbladder, liver, and pancreas. However, more recently, hepatology has ceased to be considered a subtopic within the field of gastroenterology and has become a recognized medical speciality.
Hepatology primarily is concerned with the liver. As one of the body's largest organs, the liver performs a wide range of functions related to the metabolism and conversion of dietary nutrients into compounds that can be readily absorbed by the body. It also plays a major role in the elimination of toxins. Hepatology also covers the gallbladder, pancreas, and biliary tree. The gallbladder produces, stores, and helps deliver bile, a digestive fluid used to help the body break down fatty foods. The pancreas has two main functions: It produces enzymes used in digestion, and it helps regulate the body's blood sugar levels. The biliary tree is comprised of a system of vessels that transport digestive secretions produced by the liver, gallbladder, and pancreas into the duodenum, an area of the small intestine. In the small intestine, food that initially was broken down by the stomach is further digested and converted into usable forms of energy.
Overview
Given its involvement in the digestive process and the elimination of toxins from the body, the liver is prone to a wide range of diseases and disorders that can impair its proper function. One of the most common such conditions is hepatitis, a group of viral diseases that affect the liver. According to research, hepatitis B and hepatitis C may be responsible for up to 80 percent of all cases of liver cancer. Liver cancer also has strong associations with excessive alcohol consumption, the consequences of which include conditions such as fatty liver disease and cirrhosis of the liver. These diseases are primary areas of focus for hepatologists. While hepatologists are involved in the diagnosis, treatment, management, and study of liver cancer, patients with liver cancer usually are treated by cancer specialists known as oncologists.
Other common ailments and conditions that are studied, diagnosed, and treated by hepatologists include jaundice, enzyme deficiencies, and liver diseases related to genetics and/or metabolism. Hepatologists also are involved in cases of drug abuse and drug overdose, as many drugs are processed and eliminated from the bloodstream via the liver.
Hepatologists play major roles in the medical teams that conduct and oversee liver transplants. While they are relatively rare, liver transplants can be lifesaving procedures for individuals whose livers are no longer capable of functioning properly. This condition is known as liver failure, which can affect patients of all ages. In 2014, approximately 7,200 liver transplants were performed in the United States, and a further 15,000 patients were on waiting lists for liver transplants.
Other medical procedures commonly performed by hepatologists include endoscopic retrograde cholangiopancreatography, transhepatic pancreato-cholangiography, and the installation of transjugular intrahepatic portosystemic shunts. Endoscopic retrograde cholangiopancreatography is a diagnostic test used to identify many diseases of the pancreas and biliary tree. Transhepatic pancreato-cholangiography is a type of X-ray that doctors use to find blockages in the liver and/or bile ducts. Transjugular intrahepatic portosystemic shunts are artificial pathways between the portal veins found in the gallbladder, gastrointestinal tract, pancreas, and spleen and in the hepatic veins found in the liver. They often are created to reduce pressure in the blood vessels serving the liver in patients with advanced cases of liver cirrhosis.
Two of the hepatology field's major medical journals are Hepatology and the Journal of Hepatology. Hepatology is the official medical publication endorsed by the American Association of the Study of Liver Diseases (AASLD), while the Journal of Hepatology is the official periodical of the European Association for the Study of the Liver (EASL). Both publications feature essays, reviews, and case studies related to clinical research and advancements in the field of hepatology.
Bibliography
"Biliary Tree." Medical University of South Carolina Digestive Disease Center, http://www.ddc.musc.edu/public/organs/biliary-tree.html. Accessed 21 Apr. 2017.
Cross, Tim. Liver Disease in Clinical Practice. Springer, 2016.
Greenberger, Norton, et al. Current Diagnosis & Treatment: Gastroenterology, Hepatology & Endoscopy. 3rd ed., McGraw Hill Professional, 2015.
Joshi, Deepak, et al. Hepatology at a Glance. John Wiley & Sons, 2015.
"Liver Transplant." Mayo Clinic, http://www.mayoclinic.org/tests-procedures/liver-transplant/home/ovc-20211840. Accessed 21 Apr. 2017.
"Medical Definition of Hepatology." MedicineNet, 13 May 2016, http://www.medicinenet.com/script/main/art.asp?articlekey=19427. Accessed 21 Apr. 2017.
Robertson, Sally. "What Is Hepatology?" News-Medical, 19 Nov. 2014, http://www.news-medical.net/health/What-is-Hepatology.aspx. Accessed 21 Apr. 2017.
"What Is a Gastroenterologist?" American College of Gastroenterology, http://patients.gi.org/what-is-a-gastroenterologist/. Accessed 21 Apr. 2017.