Editing Hepatology

{{Short description|Medical specialty}}
{{About|the branch of internal medicine|the compound literary or narrative work|heptalogy|the study of amphibians|herpetology|the study of liverworts|hepaticology|the journal|Hepatology (journal)}}
{{Infobox Occupation
| name= Hepatologist
| image=
| caption=
| official_names= Doctor, Medical Specialist
<!------------Details------------------->
| type= [[Specialty (medicine)|Specialty]]
| activity_sector= [[Medicine]]
| competencies=
| formation=
* [[Doctor of Medicine]] (M.D.)
OR
* [[Doctor of Osteopathic Medicine]] (D.O.)
OR
* [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.)
OR
*[[Bacculareus Medicinae, Bacculareus Chirurgiae]] (M.B.Ch.B)
AND
*[[Internal Medicine Specialiazation]]
AND
*[[Gastroenterology Subspecialization]]
AND
*[[Extra training as a Gastroenterologist in Hepatology and Transplant Hepatology]]
| employment_field= [[Hospital]]s, [[clinic]]s
| related_occupation=
}}

[[File:ERCP stone.jpg|right|thumb|Fluoroscopic image of [[common bile duct]]]]
'''Hepatology''' is the branch of [[medicine]] that incorporates the study of [[liver]], [[gallbladder]], [[biliary tree]], and [[pancreas]] as well as management of their disorders. Although traditionally considered a sub-specialty of [[gastroenterology]], 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]] 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.<ref name="urlWHO | Hepatitis B">{{cite web
|url=https://www.who.int/mediacentre/factsheets/fs204/en/index.html
|title=WHO &#124; Hepatitis B
|access-date=2010-03-17
}}</ref>  Up to 80% of [[liver cancer]]s can be attributed to either hepatitis B or [[hepatitis C]] virus. In terms of [[Mortality rate|mortality]], the former is second only to smoking among known agents causing [[cancer]]. With more widespread implementation of [[vaccination]] and strict [[Screening (medicine)|screening]] before [[blood transfusion]], lower [[infection]] rates are expected in the future.{{Citation needed|date=December 2016}} In many countries, however, overall alcohol consumption is increasing, and consequently the number of people with [[cirrhosis]] and other related complications is commensurately increasing.{{Citation needed|date=March 2010}}

[[File:Hepato-biliary.jpg|thumb|Schematic diagram of hepato-biliary system]]

==Scope of specialty==
As for many medical specialties, patients are most likely to be referred by family physicians (i.e., GP) or by physicians from different disciplines. The reasons might be:
*  Drug overdose. [[Paracetamol hepatotoxicity|Paracetamol overdose]] is common.
* [[Gastrointestinal bleeding]] from [[portal hypertension]] related to liver damage
* Abnormal blood test suggesting [[liver disease]]
* [[Enzyme]] defects leading to bigger liver in children commonly named [[storage disease]] of liver
* [[Jaundice]] / [[Hepatitis]] virus positivity in blood, perhaps discovered on screening blood tests
* [[Ascites]] or swelling of [[abdomen]] 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 [[Endoscopic retrograde cholangiopancreatography|ERCP]] for diagnosing diseases of biliary tree or their management
* [[Fever]] with other features suggestive of infection involving mentioned organs. Some exotic [[tropical]] diseases like [[hydatid cyst]], [[kala-azar]] or [[schistosomiasis]] may be suspected. [[Microbiologists]] would be involved as well
* [[multisystem disease|Systemic diseases]] affecting liver and biliary tree e.g. [[haemochromatosis]]
* Follow-up of [[liver transplant]]
* [[Pancreatitis]] - commonly due to alcohol or [[gallstone]]
* Cancer of above organs. Usually multi-disciplinary approach is undertaken with involvement of [[oncologist]] and other experts.

==History==
[[File:Blumberg.jpg|right|thumb|Dr. B Blumberg, awarded Nobel prize 1976 for discovery of hepatitis B virus]]
Evidence from autopsies on Egyptian [[mummies]] suggests that liver damage from the [[parasitic]] infection [[bilharziasis]] was widespread in the ancient society.<ref>{{cite journal |vauthors=Rosalie David A, Contis G |title=Paleopathology on schistosomiasis in Egyptian mummies |journal=Parasitol. Today (Regul. Ed.) |volume=12 |issue=4 |pages=167 |date=1996 |pmid=15275234 |doi=10.1016/0169-4758(96)80811-8}}</ref>
It is possible that the [[Greeks]] may have been aware of the liver's ability to exponentially duplicate as illustrated by the story of [[Prometheus]]. However, knowledge about liver disease in [[Classical antiquity|antiquity]] is questionable. Most of the important advances in the field have been made in the last 50 years.{{When|date=December 2016}}
* In 400 BC [[Hippocrates]] mentioned [[liver abscess]] in [[aphorisms]].<ref>{{Cite web|url=http://classics.mit.edu/Hippocrates/aphorisms.mb.txt|archiveurl=https://web.archive.org/web/20050211173218/http://classics.mit.edu/Hippocrates/aphorisms.mb.txt|url-status=dead|title=Aphorisms.mb.txt|archive-date=11 February 2005|access-date=30 November 2021}}</ref>
* [[Ancient Rome|Roman]] [[anatomist]] [[Galen]] thought the liver was the principal organ of the body. He also identified its relationship with the gallbladder and spleen.<ref>{{cite web |url=http://www.stanford.edu/class/history13/earlysciencelab/body/liverpages/livergallbladderspleen.html |title=History of Liver, Gallbladder, and Spleen |access-date=18 May 2007 }}</ref>
* Around 100&nbsp;CE [[Aretaeus of Cappadocia]] wrote on jaundice<ref name="lee">{{cite book |editor=H. S.J. Lee |title=Dates in Gastroenterology: A Chronological Record of Progress in Gastroenterology over the Last Millennium (Landmarks in Medicine) |publisher=Informa Healthcare |date= 1999|isbn=1-85070-502-X }}</ref>
* In the medieval period [[Avicenna]] noted the importance of urine in diagnosing liver conditions.
* In 1770, French anatomist [[Antoine Portal]] noted bleeding due to [[oesophageal varices]],<ref>{{cite journal |display-authors=4|author=Moodley J|author2=Singh B|author3=Lalloo S|author4=Pershad S|author5=Robbs JV |title=Non-operative management of haemobilia |journal=The British Journal of Surgery |volume=88 |issue=8 |pages=1073–76 |date=2001 |pmid=11488792 |doi=10.1046/j.0007-1323.2001.01825.x|s2cid=8124234|doi-access=free }}</ref>
* In 1844, Gabriel Valentin showed pancreatic juices break down food in digestion.
* 1846 Justus Von Leibig discovered [[pancreatic juice]] [[tyrosine]]<ref name="lee"/>
* 1862 [[Austin Flint, 2nd|Austin Flint]] described the production of [[Coprosterol|"stercorin"]].
* 1875 [[Victor Charles Hanot]] described cirrhotic jaundice and other diseases of the liver<ref>{{cite web |url=http://www.whonamedit.com/doctor.cfm/598.html |title=Victor Charles Hanot |website=Whonamedit.com |access-date=18 May 2007 }}</ref>
* In 1958, Moore developed a standard technique for [[Canidae|canine]] [[orthotopic]] [[liver transplantation]].<ref>{{cite web |url=http://www.emedicine.com/ped/topic2840.htm |title=eMedicine - History of Pediatric Liver Transplantation : Article by Beth A Carter, MD |website=Emedicine.com|access-date=18 May 2007 }}</ref>
* The first human liver transplant was performed in 1963 by Dr. [[Thomas Starzl|Thomas E. Starzl]] on a three-year-old male afflicted with [[biliary atresia]] after perfecting the technique on canine livers.<ref>{{cite web|url=http://www.emoryhealthcare.org/departments/Transplant/liver-transplant/History.html |title=History of Liver Transplantation |access-date=8 September 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090830002039/http://www.emoryhealthcare.org/departments/Transplant/liver-transplant/History.html |archive-date=August 30, 2009 }}</ref><ref>{{cite journal |display-authors=4|author=STARZL TE|author2=MARCHIORO TL|author3=VONKAULLA KN|author4=HERMANN G|author5=BRITTAIN RS|author6=WADDELL WR |title=Homotransplantation Of The Liver In Humans |journal=Surgery, Gynecology & Obstetrics |volume=117 |pages=659–76 |date=1963 |pmid=14100514 |pmc=2634660}}</ref>
* [[Baruch S. Blumberg]] discovered hepatitis B virus in 1966 and developed the first vaccine against it 1969. He was awarded the [[Nobel Prize in Physiology or Medicine]] 1976.<ref>{{cite web |url=http://nobelprize.org/nobel_prizes/medicine/laureates/1976/blumberg-autobio.html |title=Baruch S. Blumberg - Autobiography|website=Nobelprize.org |access-date=18 May 2007 }}</ref>
* In 1989, investigators from the CDC ([[Daniel W. Bradley]]) and Chiron ([[Michael Houghton (virologist)|Michael Houghton]]) identified the hepatitis C virus, which had previously been known as non-A, non-B hepatitis and could not be detected in the blood supply.<ref name="hcvadvocate.org">{{Cite web |url=http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Brief_History_HCV_10.pdf |title=Brief_History_HCV_10.pdf |access-date=2013-06-18 |archive-url=https://web.archive.org/web/20140925071401/http://hcvadvocate.org/hepatitis/factsheets_pdf/Brief_History_HCV_10.pdf |archive-date=2014-09-25 |url-status=dead }}</ref>
* Only in 1992 was a blood test created that could detect hepatitis C in donated blood.<ref name="hcvadvocate.org"/>

The word ''hepatology'' is from [[Ancient Greek]] ἧπαρ (''hepar'') or  ἡπατο- (''hepato-''), meaning "liver", and -λογία (''-logia''), meaning "study".

==Disease classification==
1. '''[[ICD|International Classification of Disease]] ([[ICD-10|ICD 2007) – WHO classification]]''':
* Chapter XI: Diseases of the digestive system<ref>{{Cite web |url=https://www.who.int/classifications/apps/icd/icd10online/ |title=Archived copy |access-date=2020-10-05 |archive-date=2009-04-22 |archive-url=https://web.archive.org/web/20090422160923/http://www.who.int/classifications/apps/icd/icd10online/ |url-status=dead }}</ref>
** K70-K77 Diseases of liver
** K80-K87 Disorders of gallbladder, biliary tract and pancreas

2. '''[[Medical Subject Headings|MeSH (medical subject heading)]]:sam'''
* G02.403.776.409.405 ''same as "Gastroenterology"''<ref>{{Cite web|url=https://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Gastroenterology&field=entry|title=G02.403.776.409.405 ''same as "Gastroenterology"''|website=Nlm.nih.gov|access-date=30 November 2021}}</ref>
* C06.552 Liver Diseases<ref>{{cite web|url=https://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Liver%20Diseases&field=entry#TreeC06.552|title=Liver Diseases|website=Nih.gov|access-date=24 December 2016}}</ref>
* C06.130 Biliary Tract Diseases<ref>{{cite web|url=https://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Biliary%20Tract%20Diseases&field=entry#TreeC06.130|title=Biliary Tract Diseases|website=Nih.gov|access-date=24 December 2016}}</ref>
* C06.689 Pancreatic diseases<ref>{{cite web|url=https://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Pancreatic%20Diseases&field=entry#TreeC06.689|title=Pancreatic Diseases|website=Nih.gov|access-date=24 December 2016}}</ref>

3. '''[[National Library of Medicine|National Library of Medicine Catalogue]]'''<ref>{{cite web|url=http://wwwcf.nlm.nih.gov/class/index.html|archive-url=https://web.archive.org/web/20041018235154/http://wwwcf.nlm.nih.gov/class/index.html|url-status=dead|archive-date=October 18, 2004|title=NLM Classification Home Page|website=Nih.gov|access-date=24 December 2016}}</ref>
* WI 700-740 Liver and biliary tree Diseases<ref>{{cite web |url=http://wwwcf.nlm.nih.gov/class/class_wi.html#WI%20700 |title=NLM Classification Schedule WI |website=wwwcf.nlm.nih.gov |access-date=17 January 2022 |archive-url=https://web.archive.org/web/20041019173242/http://wwwcf.nlm.nih.gov/class/class_wi.html#WI%20700 |archive-date=19 October 2004 |url-status=dead}}</ref>
* WI 800-830 Pancrease<ref>{{cite web |url=http://wwwcf.nlm.nih.gov/class/class_wi.html#WI%20800 |title=NLM Classification Schedule WI |website=wwwcf.nlm.nih.gov |access-date=17 January 2022 |archive-url=https://web.archive.org/web/20041019173242/http://wwwcf.nlm.nih.gov/class/class_wi.html#WI%20800 |archive-date=19 October 2004 |url-status=dead}}</ref>
''Also see [[Hepato-biliary diseases]]''

==Important procedures==
* [[Endoscopic retrograde cholangiopancreatography]] (ERCP)
* [[Transhepatic pancreato-cholangiography]] (TPC)
* [[Transjugular intrahepatic portosystemic shunt]] ([[TIPSS]])
* [[Liver transplant]] and [[pancreas transplant]]

==See Also==
* ''[[Journal of Clinical and Translational Hepatology]]''

==References==
{{Reflist}}

{{Gastroenterology}}
{{Medicine}}
{{Authority control}}

[[Category:Hepatology| ]]
[[Category:Gastroenterology]]