Some doctors offer primary medical care, seeing a patient regularly over the long term and treating illnesses as they come along. Others specialize to varying degrees, focusing on one part of the anatomy, a group of related illnesses, or a specific group of patients. Hepatologists are among the specialists; they focus their attention on diseases and conditions of the liver. It's a narrow area of practice with specific duties.
Assessment and Diagnosis
Patients usually come to a hepatologist because their family doctor suspects a liver-related condition. The hepatologist will usually conduct a physical examination and interview the patient, looking for possible risk factors. Heavy or long-term alcohol consumption can damage the liver, and so can some prescription drugs or combinations of drugs. Hepatitis in its various forms is one of the major liver diseases, dangerous both in its own right and as a trigger for liver cancers. A hepatologist might order blood tests, a biopsy or other test procedures to help with a diagnosis.
Hepatologists treat liver diseases in a number of ways. They treat hepatitis C, which is caused by a virus, with antiviral drugs. Other versions of hepatitis are less serious, and usually require only monitoring and supportive therapies, such as pain management. They may advise patients to make lifestyle changes. For example, they may advise patients with liver damage from any cause to stop drinking alcohol to ease unnecessary strain on the liver. In extreme cases, if the liver is badly damaged by drugs, alcohol or disease, a hepatologist might recommend a transplant.
Hepatologists aren't surgeons, and they don't perform transplants themselves. However, when patients have little hope of improvement or survival through other therapies, a hepatologist can recommend them for transplantation. Some transplants use a portion of the liver from a compatible donor, while others take a whole or partial liver from a deceased donor. The hepatologist provides the patient with supportive therapy before the surgery and screens for potential donors. After the surgery, a hepatologist monitors the patient's condition for years, providing suitable medications and lifestyle coaching to promote the patient's liver health.
An aspiring hepatologist starts from the same basis as any other doctor, earning a four-year premedical degree and spending four more years in medical college. At graduation, the newly trained doctor spends three years in an internal medicine residency practicing general medicine. Next comes a three-year fellowship in gastroenterology, specializing in diseases and conditions of the digestive tract and its supporting organs. Finally, there's a one-year subspecialty fellowship in hepatology. Each stage of residency and fellowship training has corresponding sets of board examinations, administered by the Board of Internal Medicine.
- News-Medical.net: What Is Hepatology?
- Washington University School of Medicine in St. Louis: Internal Medicine
- Centers for Disease Control and Prevention: Learn More About Hepatitis C
- American Association for the Study of Liver Disease: The ABCs of Hepatitis
- American Association for the Study of Liver Disease: Introduction to the Revised American Association for the Study of Liver Diseases Position Paper on Acute Liver Failure 2011; William M. Lee, et al.
- American Association for the Study of Liver Disease: AASLD Practice Guidelines -- Evaluation of the Patient for Liver Transplantation
Fred Decker is a trained chef and certified food-safety trainer. Decker wrote for the Saint John, New Brunswick Telegraph-Journal, and has been published in Canada's Hospitality and Foodservice magazine. He's held positions selling computers, insurance and mutual funds, and was educated at Memorial University of Newfoundland and the Northern Alberta Institute of Technology.