Hepatology is a branch of medicine concerned with the study, prevention, diagnosis and management of diseases that affect the liver, gallbladder, biliary tree and pancreas. The term hepatology is derived from the Greek words “hepatikos” and “logia,” which mean liver and study, respectively.
Diseases and complications related to viral hepatitis and alcohol are the main reason for seeking specialist advice. More than two 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 cancers can be attributed to either hepatitis B or hepatitis C virus. In terms of mortality, the former is second only to smoking among known agents causing cancer. With more widespread implementation of vaccination and strict screening before blood transfusion, lower infection rates are expected in the future. In many countries however, overall alcohol consumption is increasing, and consequently the number of people with cirrhosis and other related complications is commensurately increasing.
Most care of liver disease is in the ambulatory setting, and therefore the clinical needs of patients represent those of any other chronic illness. Emphasis must be given to preventative strategies such that liver lifetime (including pre-emptive strategies related to potential allograft survival) is maximised through timely intervention and avoidance of side effects. This review addresses the pertinent practical clinical concerns faced by clinicians as they manage adult patients with chronic liver disease, with an emphasis on preventing and managing symptoms and complications directly and indirectly related to the underlying disease.
A complete history and physical examination will indicate to the clinician several clues with regard to both etiology and severity of any liver disease. Initial assessment and workup of liver disease involves widely available blood tests to determine hepatocellular versus cholestatic liver disease. Liver function tests such as INR and total bilirubin confirm the degree of liver synthetic dysfunction and indicate the need for liver transplantation, particularly in those with acute liver failure. A carefully performed abdominal ultrasound can detect, but not exclude, cirrhosis. Evaluation of the degree of liver dysfunction can be made with simple blood tests. At present, liver biopsy, despite its limitations, remains the gold standard for evaluation of hepatic fibrosis. Non‐invasive testing, including FibroTest and FibroScan, may reduce the need for biopsy, but they have not been validated across the spectrum of liver disease. Child–Turcotte–Pugh and Model for End‐stage Liver Disease scores offer the best estimate of survival of cirrhotic patients and are used as a guide for the timing of transplant for non‐malignant liver disease