Hepatology
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2008-06-26T14:57:46Z
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[[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==
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