People may sometimes refer to hepatologists as liver specialists. They are doctors trained to diagnose, manage, and treat conditions affecting the liver, gallbladder, bile ducts, and pancreas.
If a person receives a diagnosis of a liver condition, they may need the expertise of a hepatologist. These healthcare professionals are experts in diagnosing and treating liver conditions, and helping to prevent further liver injury and damage.
In this article, we will discuss what hepatologists do, when a person may need to contact one, and what to expect during their appointments.
Traditionally, experts consider hepatology a subspecialty of gastroenterology. However, it is quickly emerging as a distinct entity from gastroenterology due to the advances in the understanding and treatment of the liver.
To become a credentialed hepatologist, a person undergoes a process that typically requires the following:
- a bachelor’s degree
- 4 years of medical school to receive their Doctor of Medicine or Doctor of Osteopathic Medicine degree
- 3-year residency in internal medicine
- 3-year fellowship in gastroenterology and a 1-year fellowship in advanced and transplant hepatology or a 3-year joint fellowship in gastroenterology
- a certification exam from the American Board of Internal Medicine for both transplant hepatology and gastroenterology
Hepatologists diagnose and treat all disorders associated with the liver. These can include:
- hepatic encephalopathy
- nonalcoholic fatty liver disease
- nonalcoholic steatohepatitis
- liver damage
- liver cancer
- fatty liver disease
- metabolic liver diseases
Additionally, a hepatologist may also help treat other conditions affecting the hepatic and biliary system, such as:
- primary biliary cholangitis
- primary sclerosing cholangitis
- gallbladder cancer
- pancreatic cancer
- gallbladder inflammation
- bile duct stones
- noncancerous tumors
- bile duct cancer
Hepatologists can also:
- perform diagnostic tests
- explain a person’s treatment options
- provide treatment
- monitor individuals who will have liver surgery, such as a liver transplant
- refer a person to other specialists for further assessment and treatment
- work with other experts to offer the best care
Hepatologists may see individuals in their clinic and do consultations for people in hospital. They may also work in intensive care units, high dependency units, or liver specialist centers.
Doctors typically refer people to hepatologists for more specialized care. A general practitioner or other healthcare professional may refer a person to a hepatologist if the person has a recent diagnosis of a liver condition that requires specialist treatment.
Sometimes, a doctor may refer an individual if they cannot make a diagnosis or if they show signs or symptoms that may be due to an underlying liver problem, including:
The hepatologist will typically spend time discussing and assessing a person’s general health and symptoms. This may involve a physical exam and reviewing recent test results. They may then recommend further tests to help them assess the person’s liver function and identify a potential diagnosis.
Further tests may include:
- blood tests to examine liver function and detect signs of infection or genetic markers
- imaging scans and tests to identify stones, cysts, and tumors
Once they reach a diagnosis, they will explain a person’s treatment options and may prescribe medications and certain lifestyle changes. Hepatologists may also refer individuals to surgeons if the person’s condition requires surgery.
Some procedures hepatologists commonly perform
- Imaging tests: These may include ultrasounds to look for gallstones and suspicious growths on the hepatic organs.
- FibroScan: This is to assess the stiffness of the liver.
- Cholescintigraphy scans: Also called hepatobiliary iminodiacetic acid scans, these use radiotracers to help take pictures of the biliary system and monitor bile production.
- Endoscopic retrograde cholangiopancreatography (ERCP): This uses a combination of endoscopy and X-rays to look for problems in the bile and pancreatic ducts.
- Transhepatic pancreato-cholangiography: This is another procedure that uses an injected contrast to take clearer images of the ducts, especially when ERCP is
not an option.
- Portal pressure measuring: Hepatologists use this to diagnose portal hypertension.
- Transjugular intrahepatic portosystemic shunt: This approach involves placing a stent that connects two veins within the liver. This relieves high blood pressure in the portal vein.
- Liver biopsies: Done to remove a sample of liver tissue to help diagnose conditions.
A person’s healthcare professional will typically refer them to a hepatologist if needed. Results from blood tests, imaging, scans, or physical exams, can warrant a referral to a hepatologist. The healthcare professional may also refer them to a specialist based on their symptoms, risk factors, personal, family, or medical history.
A person may also contact a local hepatologist without a referral from their doctor. However, it is best for a person to communicate with their doctors, especially if they are unsure whether their symptoms relate to the liver. Once a person receives care from a hepatologist, the hepatologist will work closely with the person’s doctor.
Hepatologists are medical doctors trained and certified to diagnose and treat various liver conditions.
A person at risk of liver problems or who is experiencing symptoms of liver disease may consider contacting their healthcare professional for a referral to a hepatologist.
Typically, the earlier a person receives a diagnosis and treatment for a liver condition, the better their outlook will be.