Hepatology

Hepatology is the branch of medicine that focuses on the study, prevention, diagnosis and treatment of diseases that affect the liver, gallbladder, biliary tree, and pancreas. You should see a hepatologist if you have symptoms like persistent fatigue, abdominal pain, jaundice (yellowing of skin/eyes), unexplained weight loss, or if you have risk factors for liver disease such as excessive alcohol consumption, viral hepatitis, or fatty liver disease.

FibroScan is a non-invasive test that measures liver stiffness and fat content to assess liver health. It's used to detect liver fibrosis (scarring) and cirrhosis without needing a liver biopsy. You might need a FibroScan if you have hepatitis B or C, fatty liver disease, alcohol-related liver disease, or other conditions that can cause liver damage. The test is painless, takes about 10 minutes, and provides immediate results.

Early-stage liver disease can often be reversed through lifestyle changes and proper medical treatment. Fatty liver disease, for example, can improve significantly with weight loss, dietary modifications, regular exercise, and alcohol cessation. However, advanced liver damage like cirrhosis is generally irreversible, though progression can be slowed. The key is early detection and intervention through regular monitoring and working closely with a hepatologist to develop an appropriate treatment plan.

Early signs of liver disease include persistent fatigue, unexplained weakness, loss of appetite, nausea, mild abdominal discomfort in the upper right side, and changes in bowel movements. As liver disease progresses, symptoms may include jaundice (yellowing of skin and eyes), dark urine, pale stools, swelling in legs and abdomen, and easy bruising. Many people with early liver disease have no symptoms, making regular health screenings important for those at risk.

Life expectancy with cirrhosis varies greatly depending on the stage at diagnosis, underlying cause, and how well the condition is managed. Early-stage compensated cirrhosis patients can live many years with proper treatment and lifestyle changes. Advanced cirrhosis (decompensated) has a more serious prognosis. The Child-Pugh score and MELD score help doctors assess severity and prognosis. With optimal medical care, dietary management, and avoiding alcohol, many patients maintain good quality of life for years.

People with liver disease should avoid alcohol completely, limit processed foods high in sodium and preservatives, reduce saturated fats and fried foods, and minimize refined sugars. Avoid raw or undercooked shellfish due to infection risk. Iron supplements should only be taken if prescribed, as excess iron can damage the liver. Focus on a Mediterranean-style diet with plenty of fruits, vegetables, lean proteins, and whole grains. Always consult with your hepatologist or nutritionist for personalized dietary recommendations.

Fatty liver disease ranges from simple fatty infiltration to more serious non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis. Treatment focuses on addressing underlying causes: weight loss through diet and exercise, managing diabetes and cholesterol, avoiding alcohol, and taking prescribed medications. Regular monitoring with blood tests and imaging helps track progression. Most patients see improvement with consistent lifestyle changes, and early intervention can prevent serious complications.

Hepatitis A is transmitted through contaminated food/water and usually resolves on its own without long-term effects. Hepatitis B spreads through blood and bodily fluids, can become chronic, and is preventable with vaccination. Hepatitis C primarily spreads through blood contact, often becomes chronic, and can lead to serious liver damage if untreated. Hepatitis C is now curable with direct-acting antiviral medications. All forms cause liver inflammation, but transmission routes, duration, and treatment approaches differ significantly.

A liver biopsy may be needed when blood tests and imaging cannot provide enough information about liver damage, to determine the exact cause of liver disease, assess inflammation severity, or monitor treatment effectiveness. The procedure involves inserting a thin needle through the skin to collect a small liver tissue sample. It's typically done as an outpatient procedure with local anesthesia. Non-invasive alternatives like FibroScan are often used first, but biopsy remains the gold standard for definitive diagnosis.

Liver function tests (LFTs) include ALT, AST, alkaline phosphatase, bilirubin, albumin, and prothrombin time. Elevated ALT and AST indicate liver cell damage, while high alkaline phosphatase suggests bile duct problems. Elevated bilirubin causes jaundice, low albumin indicates poor liver protein production, and prolonged clotting time suggests impaired liver function. Abnormal results don't always mean serious disease - they can be caused by medications, infections, or temporary conditions. Your hepatologist will interpret results in context with symptoms and other tests.