Hepatology 140432 221884774 2008-06-26T14:57:46Z DOI bot 6652755 Citation maintenance. Formatted: title. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. [[Image:ERCP stone.jpg|right|thumb|Fluoroscopic image of [[common bile duct]]]] '''Hepatology''' is the branch of [[medicine]] that incorporates study of [[liver]], [[gallbladder]], [[biliary tree]] and [[pancreas]] as well as management of their disorders. [[Etymologically]] the word ''Hepatology'' is formed of [[ancient Greek]] ''hepar''(ηπαρ) or ''hepato-''(ηπατο-) meaning ' liver' and suffix ''-logia''(-λογια) meaning 'word' or 'speech'. Although traditionally considered a sub-specialty of [[gastroenterology]], rapid expansion has led in some countries to doctors specialising solely on this area, who are called '''hepatologists'''.<br /> Diseases and complications related to viral hepatitis and alcohol are the main reason for seeking specialist advice. One third of world population has been infected with [[Hepatitis B]] virus at some point in their life. Although most of them would clear the virus from the body, approximately 350 million have become persistent carriers. Up to 80% of liver cancers can be attributed to either hepatitis B or [[Hepatitis C]] virus. In terms of number of [[Mortality rate|mortality]], the former is second only to smoking among known agents causing [[cancer]]. Hopefully, widespread implementation of [[vaccination]] and strict [[Screening (medicine)|screening]] before [[blood transfusion]] are going to lower the [[infection]] rate in future.<br /> However in many countries overall alcohol intake is on the rise and as one can expect, number of people with [[cirrhosis]] and other related complications are increasing. [[Image:Schemic diagram of Biliary system.jpg|thumb|Schematic diagram of Hepato-biliary system]] == Scope of the specialty== As for many medical specialties, patients are most likely to be referred by family physicians( i.e. GP) or by doctors from different disciplines. The reasons might be:<br /> * [[Jaundice]] * [[Gastrointestinal bleeding]] from [[portal hypertension]] related to liver damage * Abnormal blood test suggesting [[liver disease]] * [[Enzyme]] defects leading to bigger liver in children commonly named [[storage disease]] of liver * [[Hepatitis]] virus positivity in blood, perhaps discovered on screening blood tests * [[Ascites]] or swelling of [[abdomen]] from fluid accumulation, commonly due to liver disease but can be from other diseases like heart failure * All patients with advanced liver disease e.g. cirrhosis should be under specialist care * To undergo [[ERCP]] for diagnosing diseases of biliary tree or their management * [[Fever]] with other features suggestive of infection involving mentioned organs. Some exotic [[tropical]] diseases like [[hydatid cyst]], [[kala-azar]] or [[schistosomiasis]] may be suspected. [[Microbiologists]] would be involved as well * Damage to liver from other [[toxins]] like drugs. Paracetamol overdose is common * [[multisystem disease|Systemic diseases]] affecting liver and biliary tree e.g. [[haemochromatosis]] * Follow up of [[liver transplant]] * [[Pancreatitis]] - commonly due to alcohol or [[gall stone]] * Cancer of above organs. Usually multi-disciplinary approach is under taken with involvement of [[oncologist]] and other experts. == History == [[Image:Blumberg.jpg|right|thumb|Dr. B Blumberg, Awarded Nobel prize 1976 for discovery of Hepatitis B virus]]‎ Evidence from autopsies on Egyptian [[mummies]] suggest that liver damage from [[parasitic]] infection [[Bilharziasis]] was widespread in the ancient society.<ref>{{cite journal |author=Rosalie David A, Contis G |title=Paleopathology on schistosomiasis in Egyptian mummies |journal=Parasitol. Today (Regul. Ed.) |volume=12 |issue=4 |pages=167 |year=1996 |pmid=15275234 |doi=}}</ref> It is possible that [[Greeks]] might be aware of liver's ability to exponentially duplicate as illustrated by [[Prometheus]] story. However knowledge about liver diseases in [[Classical antiquity|antiquity]] was some what sketchy. Most of the important advances in the field were made in last 50 years. *In 400 BC [[Hippocrates]] mentioned [[liver abscess]] in [[apporium]] . *[[Ancient Rome|Roman]] [[anatomist]] [[Galen]] thought liver is the principle organ of the body. He also identified its relationship with gallbladder and spleen.<ref>{{cite web |url=http://www.stanford.edu/class/history13/earlysciencelab/body/liverpages/livergallbladderspleen.html |title=History of Liver, Gallbladder, and Spleen |accessdate=2007-05-18 |format= |work=}}</ref> *Around 100CE [[Areteus of cappadoca]] wrote on jaundice<ref name="lee">{{cite book |author=H S.J. Lee (Editor) |title=Dates in Gastroenterology: A Chronological Record of Progress in Gastroenterology over the Last Millennium (Landmarks in Medicine) |publisher=Informa Healthcare |location= |year= |pages= |isbn=1-85070-502-X |oclc= |doi=}}</ref> *In mideaval period [[Avicenna]] noted the importance of urine in diagnosing liver conditions. *1770 French anatomist [[Antoine Portal]], noted bleeding due to [[oesophageal varices]],<ref> {{cite journal |author=Moodley J, Singh B, Lalloo S, Pershad S, Robbs JV |title=Non-operative management of haemobilia |journal=The British journal of surgery |volume=88 |issue=8 |pages=1073–6 |year=2001 |pmid=11488792 |doi=10.1046/j.0007-1323.2001.01825.x}}</ref> *1844 Gabriel Valentin showed pancreatic juices break down food in digestion. *1846 Justus Von Leibig discovered [[pancreatic juice]] [[tyrosine]]<ref name="lee"/> *1862 [[Austin Flint, 2nd|Austin Flint]] described the production of [[Coprosterol|"stercorin"]]. *1875 [[Victor Charles Hanot]] described cirrhotic jaundice and other diseases of liver<ref> {{cite web |url=http://www.whonamedit.com/doctor.cfm/598.html |title=Victor Charles Hanot (www.whonamedit.com) |accessdate=2007-05-18 |format= |work=}}</ref> *In 1958, Moore developed a standard technique for [[Canidae|canine]] [[orthotopic]] [[liver transplantation]].<ref>{{cite web |url=http://www.emedicine.com/ped/topic2840.htm |title=eMedicine - History of Pediatric Liver Transplantation : Article by Beth A Carter, MD |accessdate=2007-05-18 |format= |work=}}</ref> *The first human liver transplant was performed in 1963 by Dr. [[Thomas Starzl|Thomas E. Starzl]] on a 3-year-old male afflicted with biliary atresia after perfecting the technique on canine livers.<ref>{{cite web |url=http://transplant.emory.edu/liver/intro/history.cfm |title= History of Liver Transplantation |accessdate=2007-05-18 |format= |work=}}</ref>, <ref>{{cite journal |author=STARZL TE, MARCHIORO TL, VONKAULLA KN, HERMANN G, BRITTAIN RS, WADDELL WR |title=Homotransplantation Of The Liver In Humans |journal=Surgery, gynecology & obstetrics |volume=117 |issue= |pages=659–76 |year=1963 |pmid=14100514 |doi=}}</ref> *[[Baruch S. Blumberg]] discovered Hepatitis B virus in 1966 and developed first vaccine against it 1969. He was awarded the [[Nobel Prize in Physiology or Medicine]] 1976.<ref>{{cite web |url=http://nobelprize.org/nobel_prizes/medicine/laureates/1976/blumberg-autobio.html |title=Baruch S. Blumberg - Autobiography |accessdate=2007-05-18 |format= |work=}}</ref> == Disease classification == 1. '''[[ICD|International Classification of Disease]] ([[ICD-10|ICD 2007)/ WHO classification]]''': *[[ICD-10 Chapter XI: Diseases of the digestive system|Chapter XI: Diseases of the digestive system]] [http://www.who.int/classifications/apps/icd/icd10online/] **[[ICD-10 Chapter XI: Diseases of the digestive system#(K70-K77) Diseases of liver|K70-K77 Diseases of liver]] **[[ICD-10 Chapter XI: Diseases of the digestive system#(K80-K87) Disorders of gallbladder, biliary tract and pancreas|K80-K87 Disorders of gallbladder, biliary tract and pancreas]] 2. '''[[Medical Subject Headings|MeSH (medical subject heading)]]:''' *[http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Gastroenterology&field=entry G02.403.776.409.405 ''same as "Gastroenterology"''] *[http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Liver+Diseases&field=entry#TreeC06.552| C06.552 Liver Diseases] *[http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Biliary+Tract+Diseases&field=entry#TreeC06.130| C06.130 Biliary Tract Diseases] *[http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Pancreatic+Diseases&field=entry#TreeC06.689| C06.689 Pancreatic diseases] 3.'''[[National Library of Medicine|National Library of Medicine Catalogue]] [http://wwwcf.nlm.nih.gov/class/index.html (NLM classification 2007):]''' *[http://wwwcf.nlm.nih.gov/class/class_wi.html#WI%20700 WI 700-740 Liver and biliary tree Diseases] *[http://wwwcf.nlm.nih.gov/class/class_wi.html#WI%20800 WI 800-830 Pancrease] ''Also see [[Hepato-biliary diseases]]'' == Important procedures == *[[Endoscopic retrograde cholangiopancreatography]](ERCP) *[[Transhepatic pancreato-cholangiography]](TPC) *[[Transjugular intrahepatic portosystemic shunt]]([[TIPSS]]) ==Publication== * The American Journal of Gastroenterology (Journal of the American College of Gastroenterology) * The American Journal of Physiology - Gastrointestinal and Liver Physiology * Archives of Gastroenterohepatology * Comparative Hepatology * Current Hepatitis Reports * European Journal of Gastroenterology and Hepatology * Gastroenterología y Hepatología * Gastroenterology (journal of the American Gastroenterological Association) * Hepatobiliary & pancreatic diseases international : HBPD INT (First Affiliated Hospital, Zhejiang University School of Medicine, China) * Hepatology (journal of the American Association for the Study of Liver Diseases) * HPB * Journal of Gastroenterology and Hepatology * HPB Surgery * Journal of Hepato-Biliary-Pancreatic Surgery * Journal of Hepatology (journal of the European Association for the Study of Liver Diseases) * Journal of Viral Hepatitis * Liver * Liver Transplantation (from the American Association for the Study of Liver Diseases) * Nature clinical practice. Gastroenterology & hepatology. ==Societies== * American Association for the Study of Liver Disease * American College of Gastroenterology * American Gastroenterological Association * American Hepato-Pancreato-Biliary Association * American Liver Society * Asian Pacific Association for the Study of the Liver * Austrian Society of Gastroenterology and Hepatology * British Society of Paediatric Gastroenterology, Hepatology and Nutrition * Canadian Association for the Study of the Liver * Czech Society of Hepatology * Danish Association for the Study of the Liver * European Association for the Study of the Liver * European Society of Paediatric Gastroenterology, Hepatology and Nutrition * French Association for the Study of the Liver * International Hepato-Pancreato-Biliary Association * International Liver Transplantation Society * Israel Association for the Study of the Liver * North American Society for Pediatric Gastroenterology, Hepatology and Nutrition * Society for Surgery of the Alimentary Tract * Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition * Swiss Association for the Study of the Liver * Turkish Association for the Study of the Liver ==References== {{Reflist}} {{Gastroenterology}} {{Medicine}} [[Category:Gastroenterology]] [[Category:Hepatology]] [[ca:Hepatologia]] [[de:Hepatologie]] [[fr:Hépatologie]] [[it:Epatologia]] [[nl:Hepatologie]] [[nn:Hepatologi]] [[pl:Hepatologia]] [[pt:Hepatologia]] [[ur:طب جگر]]