Hepatology

As a specialty of gastroenterology hepatology is called, the physiology and patho ( physio ) logy of the liver and biliary tract, as well as diagnosis and treatment of diseases includes those organs. It is not a separate subject. The term " hepatologist " is usually for a specialized liver disease gastroenterologists, except that in Germany as an occupational designation requires no special training.

Clinical pictures of Hepatology

In the congenital malformations abnormalities of the liver and intrahepatic bile ducts, including the Caroli syndrome, vascular anomalies and anomalies of the extrahepatic bile ducts are distinguished.

Disorders of bilirubin metabolism, jaundice ( jaundice) and family Hyperbilirubinämiesyndrome be divided

  • In those with elevated indirect ( " uncoupled " ) bilirubin Crohn Meulengracht, Gilbert 's disease ( icterus inter- mittens juvenilis )
  • Crigler- Najjar syndrome type I and II

The inflammatory liver diseases are viral infections (hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E and hepatitis G), non-viral infections (bacterial infections, fungal infections and parasites such as Amoeba abscess, hydatid disease and liver fluke ) Granulomatous inflammation, autoimmune hepatitis and inflammation of the bile ducts ( cholangitis, primary biliary cirrhosis, primary sclerosing cholangitis, acute and chronic cholecystitis ) divided.

Play a numerically large role gallstone disease, toxic liver damage caused by eg alcohol or drugs and fatty liver. As a result of various liver diseases, it can lead to liver fibrosis, cirrhosis and liver failure occur. Less common are metabolic disorders such as hemochromatosis, Wilson's disease ( Hepatolenticular degeneration or copper storage disease), alpha- 1 antitrypsin deficiency, glycogen storage diseases and porphyria.

Among the malignant neoplasms of the liver liver metastases most commonly, hepatocellular carcinoma, Cholangiocellular carcinoma, cystadenocarcinoma and hepatoblastoma are rare.

In childhood play of neonatal jaundice and congenital bile duct changes, including Byler syndrome (progressive familial intrahepatic cholestasis ), Alagille syndrome, and Reye's syndrome, the most important role in pregnancy, acute fatty liver of pregnancy and acute Schwangerschaftcholestase.

Methods of investigation

Laboratory values

  • Bilirubin: direct, indirect
  • Bilirubin excretion in the urine
  • AST (formerly GOT), ALT (formerly GPT), glutamate dehydrogenase: these three enzymes are components of liver cells and grown measurably in their damage, such as viral hepatitis. GOT and GPT are collectively known as transaminases.
  • CHE, prothrombin time or INR, and albumin are factors that are produced in the liver, dependent, and thus serve the assessment of liver synthesis capacity.
  • Hepatitis serology in suspected an infectious events as well as for activity assessment with known infection.
  • γ -GT, AP: these enzymes are present in the bile ducts and are released in accordance with increased if they are damaged ( for example, in a bile duct inflammation ). They are collectively referred to as cholestasis.
  • Iron, ferritin, copper and Caeruloplasminspiegel in suspected disorders of iron or copper metabolism such as hemochromatosis and Wilson's disease

Imaging methods

To represent the tissue architecture as well as any space-occupying lesions

  • Ultrasound
  • Computed tomography
  • Magnetic Resonance Imaging
  • ERCP

Biopsy

When liver biopsy is an invasive procedure for removing tissue of the liver with or without ultrasound guidance. It follows the investigation of microscopic tissue architecture ( histology).

Treatment methods of Hepatology

  • Diet (see hepatic encephalopathy )
  • Viral hepatitis Vaccination against hepatitis A and B
  • Antivirals and interferons in viral hepatitis B or C
  • Diuretic
  • Beta blocker
  • Portosystemic shunt

Hepatologien in Europe

  • Hepatology at the University and Inselspital Bern ( Switzerland )

Swell

  • Herold: Internal Medicine, 2001
  • Böcker, thinking, Heitz: pathology, Urban and Fischer
  • Hepatology
  • Medical field
Organ (anatomy) Congenital disorder Caroli disease Dubin–Johnson syndrome Virus Reye syndrome Aspartate transaminase Alanine transaminase Alkaline phosphatase Ceruloplasmin
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