Hepatologist: why and when to consult?

Hepatologist: why and when to consult?

The hepatologist is the doctor specializing in diseases of the liver, bile ducts and spleen. Most gastroenterologists practice this specialty. What is the role of the hepatologist? When and for which pathologies should you consult?

 

What is a hepatologist?

The hepatologist is a specialist in hepatology. This discipline is the branch of medicine concerned with diseases of the liver, bile ducts and spleen. Hepatology is a specialty of gastroenterology (medicine of the digestive system). In this regard, we are also talking about “ gastroenterologist and hepatologist ».

The hepatobiliary diseases can have several possible etiologies:

  • infection ;
  • tumor;
  • metabolic or autoimmune disorder;
  • genetic abnormality;
  • poor lifestyle (alcoholism, obesity).

It is not uncommon for hepatobiliary disorders to be responsible for complications of a renal, neurological, cardiovascular, pulmonary nature, etc. In these cases, the patient consults (in addition to his or her hepatologist) doctors from other specialties.

What is the role of the hepatologist?

When blood tests prescribed by a general practitioner put on the way to a hepatobiliary pathology, the patient is referred to a gastroenterologist and hepatologist. This last :

  • make a precise diagnosis ;
  • look for find the cause of the disease ;
  • offers the appropriate available treatments.

If the condition requires surgical treatment, the patient is treated by a hepatologist specializing in liver surgery and anesthesia (digestive surgery, hepato-bilio-pancreatic and liver transplantation).

 

Hepatologist: what therapeutic indications?

The hepatologist supports all diseases of the liver, bile ducts and spleen. The pathologies encountered in hepatology are very numerous.

Cancers  

  • Primary cancers of the liver and bile ducts : the hepatocellular carcinoma ou hepatocarcinoma (CHC) represents nearly 70% of primary liver cancers. Dyears 90% of cases, they develop against a background of chronic liver disease.
  • Cancer metastases affecting the liver, bile ducts or even the spleen.

Autoimmune diseases

  • Primary biliary cholangitis (PBC) causes progressive and irreversible destruction of the bile ducts. This disease affects between 10 and 40 individuals per 100 inhabitants;
  • Primary sclerosing cholangitis (CSP) is chronic inflammation, fibrosis, and progressive destruction of the bile ducts inside or outside the liver. Its prognosis is poor, progressing gradually to biliary cirrhosis. This affection would affect nearly 5000 people in France;

Chronic inflammatory diseases

  • Cirrhosis of the liver refers to severe and chronic inflammation of the liver. It results from advanced liver fibrosis. This irreversible condition is mainly of alcoholic or hepatic origin. In France, it affects between 150 and 200 people per million inhabitants. Causing nearly 15 deaths each year, it is the 000th cause of death in France.

Obstructive diseases

  • Gallstones (gallstones) is a frequent condition affecting nearly 15% of the adult population in France. This obstruction of the tract or gallbladder results from insoluble stones made up of cholesterol salts.

Genetic diseases

  • Hemochromatosis is a genetic disease that affects nearly one in a thousand people in France. It causes a gradual accumulation of dietary iron in the body. The treatment consists of a regular blood sample (bleeding).

Autoimmune diseases

  • Autoimmune hepatitis is a chronic inflammation of the liver of autoimmune origin. This rare condition (less than one case per 100 inhabitants) of unknown origin puts you at risk of cirrhosis and liver failure.

Genetic and / or hereditary diseases

  • Gilbert’s disease, genetic liver disease due to a partial deficit in the elimination of bilirubin. Its only clinical manifestation is jaundice.
  • Wilson’s disease is a rare disease that causes a toxic build-up of copper in the liver and brain. Early treatment helps prevent hepatic and neurological complications
  • Hereditary liver diseases such as syndrome de Dubin-Johnson, the Rotor syndrome, Criggler-Najjar syndrome.

Viral hepatitis

  • Hepatitis a is an infectious disease linked to hepatitis A virus (VHA). Contamination occurs through ingestion of soiled food or through sexual intercourse with a contaminated person. It is recommended to be vaccinated in anticipation of a stay in a country where sanitary conditions are insufficient.
  • Hepatitis B is a chronic disease associated with infection with hepatitis B virus (HBV). In France, preventive vaccination is compulsory for all infants.
  • Hepatitis C is a disease transmitted through the blood. It still affects nearly 3% of the world’s population to this day, but France plans to eliminate it before 2025.
  • Hepatitis D cannot be triggered without simultaneous or prior infection with the hepatitis B virus. This HDV-HBV co-infection is the most serious and most rapid form of chronic viral hepatitis. It is rare in France.
  • Hepatitis E is present all over the world, reaching nearly 20 million people. It is spread by ingestion of water contaminated with human excreta.

Benign liver tumors

  • There are three types of benign liver tumors:hepatic angioma et nodular hyperplasia which usually do not require treatment. Surgical resection is however necessary in case ofhepatocellular adenoma in order to avoid any malignant development.

Parasitic liver disease

  • For example : alveolar or cystic echinococcosis, caused by tapeworms of the genus Echinococcus.

Complications of hepatobiliary diseases

  • THEHepatic insufficiency is physiological liver failure which may be acute (related to hepatitis) or chronic (due to cirrhosis).
  • La cholestase is a slowing down or even stopping the bile circulation responsible for a defect in the transport of bile acids from the liver to the intestine, and an accumulation of bile acids in the blood and tissues. Liver, biliary or pancreatic disorders can be the cause.

Hepatologist: when to consult?

If you have symptoms suggestive of liver disease  

There are specific symptoms of liver disease that should prompt you to seek immediate medical attention, who will perform blood tests:

  • jaundice or jaundice (this is a sign of elevated bilirubin levels);
  • a swollen and hard belly (ascites);
  • other non-specific signs: nausea, vomiting, weight loss, fatigue.

In case of alteration of certain blood markers

In order to detect hepatobiliary disease, certain biological markers should be monitored:

  • Transaminases ASAT, ALAT);
  • Les Phosphatases Alcalines ;
  • Gamma GT (note that the increase in this level associated with that in the level of alkaline phosphates are a sign of cholestasis);
  • Total and Conjugated Bilirubin (if there is an increase, the patient has jaundice);
  • PT and Factor V (a collapsed PT as well as a low factor V are signs of severity of the liver damage).  

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