VERIFIED CONTENTAuthor: Dominika Wilk
A hepatologist is a specialist in liver diseases. You must go to it in case of poor liver tests results, abnormal ultrasound of the liver or problems with the bile ducts and gall bladder. Also other symptoms, such as: ascites, the feeling of distension in the right hypochondrium, or poor digestion and fat absorption, should refer us to this type of specialist.
Hepatologistheals a diseased liver. However, a malfunctioning liver rarely makes itself felt and it is often difficult to catch the moment when it is necessary to see a doctor. However, there are a number of symptoms that may indicate a malfunctioning liver.
Common symptoms that suggest liver disease
One of the common symptoms of a diseased liver is excessive stretching in the right side. This is the case, for example, with fatty liver. This is the result of the larger volume of the liver pressing against the capsule surrounding its peritoneum. Because the liver does not hurt by itself, it is not innervated, so even despite the ongoing inflammation and various dysfunctions, we will not feel any pain on its part.
We can also hear about an enlarged liver … pain in the right shoulder. It is rarely associated with the liver, but it is one of the symptoms of liver failure. In addition, a very common symptom is chronic fatigue, and - in more advanced cases, yellowing of the skin and whites of the eyes.
There may also appear ascites, which is already an alarm symptom, usually indicating cirrhosis of the liver.
Research worth visiting a hepatologist
If during routine blood tests and standard liver tests performed once a year, it turns out that the results are significantly abnormal, it is worth visiting a hepatologist. Before that, however, these tests should be supplemented with the concentration of bilirubin, alkaline phosphatase or GGTP.
They will allow the doctor to fully assess the condition of the liver and order further, more detailed tests. During the visit to the hepatologist, we usually have abdominal palpation and ultrasound. The doctor may also order a liver and biliary scintigraphy, as well as computed tomography or magnetic resonance imaging.
The important information is thatthat you need to prepare for the liver ultrasound examination by following an easily digestible diet on the day of the examination and fasting for 6 hours before the examination. When we go to the ultrasound in the morning, we come on an empty stomach, and on the day before we have a light supper.
Diseases of the liver and biliary tract that are treated by a hepatologist
Fatty liver
Fatty liver affects not only people who abuse alcohol. Also people with intestinal problems, diabetes, fasting or deficient diets, genetic Wilson's disease, taking certain medications such as amiodarone, tamoxifen, methotrexate, diltiazem - may have problems with this disease.
A fatty liver is nothing more than the accumulation of fat droplets inside the hepatocytes (liver cells). It causes their excessive enlargement, and therefore also the increase in the volume of the entire liver. It leads to dysfunction of liver cells, therefore, during treatment, the aim is to reduce fatty liver, which in such a state cannot function properly.
During a visit to the hepatologist, we usually find out whether we are dealing with simple fatty steatosis (easily cured by diet alone) or with the accompanying inflammation or cirrhosis of the liver.
To diagnose nonalcoholic fatty liver disease, the physician must find out if the patient consumes more than 20 g of alcohol a day (women) or no more than 40 g a day (men). If this amount is higher, the disease is classified as alcoholic fatty liver disease. In addition, he must confirm that the results of the ALAT and AsPAT tests are abnormal and that the ultrasound, CT or MRI shows a fatty liver.
A necessary element in determining this disease entity is also the exclusion of other diseases that could lead to the accumulation of fat droplets in hepatocytes, e.g. autoimmune disease or Willson's disease.
Autoimmune hepatitis
Autoimmune hepatitis, like other liver diseases, does not have the characteristic symptoms. However, you need to see a hepatologist when laboratory tests show hypergammaglobulinemia and elevated levels of G-class immunoglobulins.
Also a slight increase in APL and GGTP, chronic fatigue and itching of the skin may suggest the presence of this particular disease.
The age of the person suffering from hepatitis may also be a clue to the diagnosis of autoimmune hepatitis. Usually it affects people between 40 and 60 years of age (more often women), such asalso young people in adolescence.
The hepatologist suspects autoimmune hepatitis and refers the patient to ANA anti-nuclear antibodies as well as ASMA anti-smooth muscle antibodies. In addition, he has to test (especially in young people) - antibodies against microsomes of the liver and kidneys, anti-LKM.
Urolithiasis
Gallstone disease is one of the simpler diseases to diagnose. It is distinguished by abdominal pain, nausea, vomiting, flatulence, a bitter taste in the mouth, systolic pain in the right ridge, yellowing of the eye proteins due to bile stasis.
The most characteristic symptom of this disease is an attack of biliary colic, which is caused by a stone advancing in the bile ducts and which causes a sudden, contractile attack in the right hypochondrium or epigastric region. This is often accompanied by nausea and vomiting.
If the above-mentioned ailments also appear in our country, it is necessary to visit a hepatologist. After an interview, a specialist will perform an ultrasound to detect deposits in the gallbladder and bile ducts. A quick diagnosis of gallstone disease is necessary to maintain not only he alth, but also the life of the patient.
Often, chronic urolithiasis can lead to inflammation, including acute pancreatitis, as well as severe inflammation of the gallbladder, which can be fatal.
Hepatitis
A hepatologist is a specialist in treating all types of hepatitis, e.g. A, B, C, D, E. He treats them both in the acute and chronic phase and monitors them when they are in the latent phase (the patient is infected, but the infection does not develop and shows no symptoms).
For treatment of inflammatory liver disease, appropriate antibody testing must first be performed. These are antibodies, e.g. anti-HBs, anti-HCV, anti-HDV.
In the case of B virus infection, these antibodies differ depending on the stage of the infection at which it was detected. For example, in the acute, first phase of infection, HBeAg is tested, and over the next few months, HBsAg is tested. In addition, in the case of inflammation of the liver, the hepatologist always orders ALT and AST liver tests.
Cirrhosis of the liver
Cirrhosis of the liver is such a serious disease that it is necessary not only to be treated under the supervision of a hepatologist, but also, in a critical condition, to put yourself in the hands of a surgeon for a new liver transplant.
This disease is the result of chronic liver inflammation and its excessive fibrosis. Is characterised byreplacing he althy liver parenchyma with fibrotic, damaged tissue and the presence of numerous nodules.
One third of patients may be asymptomatic, while the rest may experience a feeling of breakdown, dyspeptic ailments, yellowing of the proteins, swollen ankles, loss of armpit and pubic hair.
Men with cirrhosis of the liver may notice the loss of facial hair as well as atrophy of the testicles, as well as enlargement of the mammary glands (gynecomastia). Due to the fact that the development of this disease may result in liver cancer or even death, close cooperation between the hepatologist and the patient is necessary and constant monitoring of the disease progression.
Hepatic encephalopathy
Hepatic encephalopathy is a neuropsychic disorder resulting from insufficient liver function. A poorly working liver is not able to neutralize the toxic ammonia formed, among others, by during various metabolic changes, the consequence of which is intoxication of the body leading to disturbances in the nervous system.
A person with hepatic encephalopathy, depending on the severity of the disease, has problems with: concentration of attention, memory impairment, hand tremors, slurred speech.
She is also lethargic and apathetic, she may develop nystagmus and extrapyramidal symptoms. To determine the existence of this disease, the hepatologist tests the patient's blood ammonia level, and may also order psychometric tests or CFF.
In turn, in order to exclude the existence of other diseases affecting the disturbances of the nervous system, he orders computed tomography.
Tumors of the liver, bladder and bile ducts
Each cancer related to the liver, gallbladder or bile ducts should be consulted by a hepatologist.
It deals with both benign forms of neoplasms, e.g. papillomas or gallbladder adenomas, as well as gallbladder cancer, bile duct cancer, or, for example, hepatocyte adenocarcinoma.
Although the greatest role in the diagnosis and treatment of this type of cancer is played first by radiologists, and then by oncologists-surgeons, the hepatologist should be present throughout the treatment process.