Hepatologists and Information on Hepatology

Hepatology is a medical specialty that deals with pathological and abnormal processes and conditions of the liver and the biliary tract, including the gallbladder.

These include:

• Diagnosis and 
• treatment of liver and biliary tract diseases

Hepatology is a subspecialty of gastroenterology. Gastroenterology deals with diseases of the gastrointestinal tract and the associated organs (liver, gallbladder, pancreas).

Weighing about 1.5 kg, the liver is the largest internal organ in the human body and is located in the upper right abdomen @ Henrie /AdobeStock

A liver disease is also known as hepatopathy. A hepatologist treats diseases that affect the liver or the biliary tract.

The following liver diseases are possible:

• Infectious liver disease: viral hepatitis or liver abscess
• Toxic liver disease: alcohol-induced liver disease and drug-induced liver disease
• Benign and malignant tumors: liver cancer, liver metastases, or gallbladder cancer

Doctors classify liver cancer into hepatocellular carcinoma and cholangiocarcinoma, depending on the origin of the tumor cells.

Liver metastases are secondary tumors originating from a primary tumor growing elsewhere in the body. Alcohol abuse and viral hepatitis can cause cirrhosis of the liver

Typical gallbladder and biliary tract diseases include:

• Gallstones (choledocholithiasis, cholecystolithiasis)
• Inflammatory conditions such as cholecystitis (inflammation of the gallbladder), cholangitis (inflammation of the bile ducts), and
• Bile flow disorders

If the liver is affected by hepatitis, the skin and eyes turn yellow @ blackday /AdobeStock

During the clinical examination, the liver specialist looks for complaints and symptoms.

The following are also used:

• Laboratory tests
• Medical history
• Imaging techniques

The most important imaging technique in liver diagnostics is an abdominal ultrasound (sonography).

It can be used to:

• Detect gallstones
• Monitor the progression of liver cirrhosis and 

identify signs of liver metastases and liver cancer

Computed tomography (CT) is a complementary test in liver diagnostics, as it provides a detailed image of the liver. It also confirms suspected tumors (liver cancer, liver metastases, gallbladder cancer). CT can also be used to detect liver hemorrhages and liver cirrhosis.

Magnetic resonance imaging (MRI) is also a highly sensitive diagnostic tool that complements ultrasound in liver diagnostics.

Endoscopic retrograde cholangiopancreatography (ERCP), a type of endoscopy, can be used to perform both diagnostic and therapeutic procedures.

If liver disease is suspected, a liver specialist takes a tissue sample from the liver and examines it under a microscope.

Liver tissue sample @ Volha /AdobeStock

This allows the liver specialist, for example, to distinguish cancer cells from harmless cells or to diagnose liver cirrhosis.

As part of laboratory tests, the liver specialist examines liver function values (bilirubin, AST, ALT, GLDH, GGT, etc.) in the blood. If these levels deviate from normal ranges, this may be an initial indication of liver disease (cirrhosis or hepatitis).

Serology uses immune responses to determine whether the patient has already been exposed to a pathogen, such as the hepatitis virus.

The treatments used in hepatology depend on the type and severity of the liver disease, as well as the patient’s overall health.

As a preventive measure, doctors recommend vaccination against hepatitis A and hepatitis B.

If the patient has already developed hepatitis, medications against the hepatitis viruses (antiviral drugs) are used.

Since liver cancer responds poorly to cytostatic drugs, partial removal of the liver (partial liver resection) is the treatment of choice for liver cancer.

For inoperable liver cancer, minimally invasive procedures are also used.

Examples include:

• Laser-induced thermotherapy
• Radiofrequency-induced thermotherapy
• Cryotherapy

Doctors can also surgically remove liver metastases.

A portosystemic shunt is used to reduce portal hypertension, which occurs in cirrhosis of the liver. This procedure creates a connection between two blood vessels.

A liver transplant is the last resort. It is only performed when the liver is so severely damaged that liver failure is imminent.

A specialist in hepatology is called a hepatologist (liver specialist, liver expert). The term “hepatologist” is not entirely accurate, because there is no specific training program for this designation in Germany. 

A gastroenterologist is sometimes referred to as a hepatologist because they have completed advanced training to become a specialist in internal medicine and gastroenterology.

A hepatologist is therefore an internist who specializes in diseases of the gastrointestinal tract (specifically the liver and biliary tract).