DR AABHA NAGRAL

Who is a hepatologist?

A hepatologist is a specialist in the branch of medicine called Hepatology, which includes the study of body parts such as the liver, the gallbladder, the biliary tree, and the pancreas. Hepatology was traditionally regarded as a subspecialty of gastroenterology, but recent advances in the understanding of this subspecialty have made hepatology a field of its own.

Hepatologists deal most frequently with diseases related to alcohol and viral hepatitis that impacts millions of people worldwide and has been associated with a number of poor outcomes such as liver transplantation and liver cancer. Particularly, hepatitis C  and hepatitis B frequently cause liver cancers, and alcohol consumption has been associated with cirrhosis and other such complications.

These practitioners can treat adult or pediatric patients, and to become a hepatologist, you must complete undergraduate study, receive a Doctor of Medicine or a Doctor of Osteopathic Medicine degree, and then complete a three-year residency in gastroenterology followed by a fellowship of two or three years in that field.

When should I see a hepatologist?

Right under your ribs on your right side, the liver is a reddish-brown organ about the size of your fist. It helps get rid of toxins in your body and when it doesn't do its job, your body can't use your blood and food the way it's supposed to. If the general practitioner detects or suspects that your liver isn't in perfect working order, you may be referred to a hepatologist.

A general practitioner may refer a patient to a hepatologist for a variety of reasons including drug overdose, jaundice, ascites, gastrointestinal bleeding from portal hypertension, enzyme defects or blood tests that indicate liver disease. Evidence of diseases in the biliary tree, fever indicating tropical diseases such as hydatid cyst, schistosomiasis, or kala-azar may also cause a general practitioner to refer a patient to a hepatologist. Hepatologists also may treat hemochromatosis or pancreatitis or conduct follow-up of the patients who have received liver transplantation.

Some signs that your liver isn't working properly include dark yellow or brownish pee and yellow skin, and chronic and severe digestive issues like heartburn or pain after eating can also indicate a condition of the liver.

You must see a hepatologist for:

• Scarring or liver damage or also called cirrhosis which is often caused by alcohol abuse.
• Hepatitis infections.
• Damage to the pancreas or biliary tract.
• Liver cancer.
• Drug overdose.
• Genetic and metabolic liver disease.
• Gallstones.
• Pancreatitis.

What kind of tests do hepatologists do?

Hepatologist performs History/liver function tests (blood sample) for Alcohol-related liver disease; Autoantibodies such as anti-nuclear antibody and anti-smooth muscle antibody (blood sample) for Autoimmune hepatitis; HFE Gene analysis for C282Y or H63D mutation (blood sample) for Haemochromatosis; Antibody test (blood sample) for Hepatitis A; Antibody, antigen tests/hepatitis B DNA (blood sample) for Hepatitis B;

Antibody test/hepatitis C RNA (blood sample) for Hepatitis C; History/liver function tests (blood sample)/ BMI/ultrasound scan appearance and liver biopsy for Fatty liver disease, non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH); Anti-mitochondrial antibody (blood sample) for Primary biliary cirrhosis; Biopsy/bile duct imaging – ERCP for

Primary sclerosing cholangitis; Genetic analysis/copper studies (blood and urine samples), slit lamp examination of the eyes for Wilson’s disease.

Other tests performed my hepatologists are Blood clotting tests, Immunology/autoimmune profile tests, Imaging tests, Endoscopic procedures, and liver biopsy.

How often should you get your liver checked?

If you’ve got hepatitis  B or hepatitis C, then you’ve got more risk of liver disease like cirrhosis (scarring), liver cancer, and liver failure. You may need treatment for your hep B or C even if you are feeling well. A regular liver check-up allows your liver health to be tracked; it allows you to discuss with your doctor how to slow the progress of liver damage and decide when to start treatment.

Your liver check-up may start with a liver function test and other tests to measure how well your liver is functioning. These blood tests can be arranged by your hepatologist or specialist. A liver ultrasound may also be done. If you are under 40, a liver check-up after 2 or 3 years will suffice. But if you are above 40 and are suffering from liver diseases and then you should get liver checked annually.

Is there a difference between a hepatologist and gastroenterologist?

Tere's a difference a hepatologist and gastroenterologist. A gastroenterologist is a specialist in the digestive system, which includes the intestines, pancreas, liver, and gallbladder. Meanwhile, hepatology is considered a sub-specialty of gastroenterology, and it only focuses on the liver, the gallbladder, biliary tree, and pancreas.

Do hepatologists perform surgery?

Hepatologists perform non-invasive diagnostic and treatment procedures, but they do not perform surgery. A hepatologist is a physician who only monitors the pre and post-op care of patients who undergo a relevant surgical procedure such as liver transplant or gallstone removal, a procedure which is performed by specialized surgeons.

What happens in your first hepatologist appointment?

Your first visit with a hepatologist will include a review of your past and current medical history. You should also bring a list of prescription medications you are currently taking as well as the dosage. It is also important to bring any relevant medical records you have in your possession so the hepatologist will have the information in your medical file. Most patients will be required to have blood work done on the first visit, and in many cases where liver conditions are suspected, the specialist may need an evaluation of the patient's digestive system which may include an upper endoscopy and a colonoscopy.