The medical specialty of hepatology deals with the dysfunctions and diseases of the liver. The term hepar is the Greek name for the organ that performs numerous important tasks in metabolism, blood formation and detoxification of the organism.
What is hepatology?
The medical specialty of hepatology deals with the functional disorders and diseases of the liver. Hepatology is a subspecialty of gastroenterology. The function of the liver cannot be considered in isolation. It is an important factor in the healthy functioning of the digestive organs and overall metabolism. Gastroenterology deals with the digestive system from the stomach through the liver and gall bladder to the individual intestinal segments. Hepatology is specifically concerned with the physiology of the liver and the diagnosis and treatment of malformations and diseases of the liver, gall bladder and bile ducts. The liver is the largest metabolic organ. It has to produce the body’s own proteins from proteins foreign to the body. It produces bile and other enzymes and messenger substances for the digestive process. It utilizes food components, stores vitamins and detoxifies the organism. The liver has a particularly pronounced ability to regenerate itself. The digestive gland weighs about 1,500 grams in an adult. The structure of the liver consists anatomically of four different liver lobes and functionally of eight different liver segments. The structure of the liver tissue is evident with many hepatic lobules. These are the actual functional tissue for the control of glucose, fat and protein metabolism. The cells of the liver are called hepatocytes. The digestive gland also contains the intrahepatic bile ducts, which carry bile into the gallbladder. In addition, the liver tissue is interspersed with periportal fields, which consist of connective tissue. Important blood vessels run within the structure of the liver.
Treatments and therapies
Many diseases can damage liver tissue and the function of the digestive gland. The most common causes of liver damage are infections triggered by viruses. Here, the various forms of jaundice (hepatitis) are especially important to think of. Bacteria can also cause an infection of the liver. In addition, there are parasites that can damage liver tissue and cause abscesses. Parasites include dog and fox tapeworm, liver fluke, and amoebae. The specialty of hepatology also includes liver inflammation caused by an autoimmune process. In autoimmune diseases, the immune system attacks and fights the body’s own tissues and structures. Another area of hepatology is diseases and dysfunctions of the gallbladder. Acute and chronic inflammation of the gallbladder is often caused by stone formation. Alcohol abuse and the use of certain medications can lead to fatty liver and even cirrhosis. Severe inflammation and toxins damage liver tissue. The liver cells are no longer able to perform their extensive tasks. This leads to liver failure. The fields of hepatology also include the diagnosis and treatment of malignant cell changes in liver tissue. The most common cause of tumors in the liver are cancers of the breast, intestine, prostate and other malignant tumor diseases. In addition to the primary tumor, metastases can form anywhere in the body. The liver is particularly frequently affected by metastases. However, there are also cancers that originate in the liver. These include hepatocellular carcinoma and hepatoblastoma. Carcinomas can also form in the bile ducts. Hepatology includes metabolic disorders that have their origin in the function of the liver. These are relatively rare diseases such as Wilson’s disease (copper storage disease), hemochromatoses (iron storage disease) and porphyrias (disorder in the production of red blood pigment). Without a functioning liver, humans do not survive. The tasks of the liver cannot be taken over by other organs. Even though liver tissue can regenerate amazingly well, there are cases in which this is no longer possible. Hepatology then tries to enable the patient to continue living by means of a liver transplant.
Diagnosis and examination methods
Hepatology has several options available to make a diagnosis and to support it with laboratory results and imaging techniques. Important liver-specific laboratory values can be determined in the blood and urine. These include direct and indirect bilirubin and liver enzymes such as AST, ALT and GLDH. If liver damage is present, enzyme levels will change and indicate inflammation. The synthesis capacity of the liver can be assessed if deviations from the normal value are measurable when checking the Quick value or the percentage of protein albumin formed in the liver. The change in the levels of liver enzymes such as γ-GT and AP indicate an inflammatory process in the bile. Altered levels of iron or copper in the blood indicate abnormal iron and copper metabolism controlled by the liver. In addition to laboratory values, imaging procedures such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are important examination methods for making a diagnosis. A new method is the examination of the liver with a fibroscan. This measures the elasticity of the liver tissue. If cirrhosis has already developed, the liver is riddled with functionless connective tissue. The more advanced this process is, the more hardened the liver is. The examination is mainly performed in clinics. Especially when malignant tissue changes are suspected, a liver biopsy is performed. During this invasive procedure, liver tissue is removed and then examined for any cancer cells that may be present.
Typical and common liver diseases
- Liver failure
- Cholestasis
- Liver cyst
