Hepatology is the medical specialty detailing the study, diagnosis and treatment of diseases relating to the liver and biliary tree.
The liver originates from endoderm and forms as an outgrowth of the duodenum. It is divided into right and left lobes; the former is approximately six times larger than the latter.1 The liver receives oxygenated blood from the hepatic artery; however, it also receives blood through the...
The biliary tree consists of; the hepatic ducts, the common hepatic ducts, the gall bladder, the cystic duct, the common bile duct and the sphincter of Oddi.3 Its function is to transport bile, which is formed in the liver, to the duodenum to aid digestion. Bile is ejected from the gall bladder, a storage organ, in the presence of cholecystokinin (CCK) to ensure it is present in the duodenum at the optimum time. The common diseases of the biliary system are; gall stones, gall-bladder polyps, sphincter of Oddi dysfunction and cancer of the gall bladder and biliary tree.4
Hepatic diseases consists of, but are not limited to; acute, chronic and drug induced hepatitis, alcoholic liver disease5, cirrhosis of the liver6, jaundice7, and hepatic cancer.7 Hepatic diseases can affect people of all ages. Jaundice is one such disease; resulting from the accumulation of billirubin, either due to overproduction, or failure of the liver to metabolise and excrete it through the bile ducts.7 Jaundice can be a symptom of many other liver diseases such as hepatitis and cancer. Hepatitis is a viral disease with five forms (A, B, C, D and E) that cause inflammation of the liver. Hepatitis B and hepatitis C can lead to cirrhosis (scaring) of the liver and hepatocellular carcinoma.5
1. Kuntz E. et al. Hepatology: Textbook and Atlas. Springer. 2008 : 18.
2. Cavendish M. Diseases and Disorders. Marshall Cavendish. 2007 : 521.
3. Dooley J.S. Sherlock’s Diseases of the Liver and Biliary Tract. John Willey and Sons. 2011 : 5.
4. Talley N.J. et al. Practical Gastroenterology and Hepatology: Liver and Biliary Disease. John Willey and Sons. 2010 : 349-381.
5. Mushahwar I.K. Viral Hepatitis: Molecular Biology, Diagnosis, Epidemiology, and Control. Gulf Professional Publishing. 2007 : vii-1.
6. Cavendish M. Diseases and Disorders. Marshall Cavendish. 2007 : 203.
7. Gilmore I. et al. Investigation of Jaundice. Medicine. January 2007 ; 35 (1) : 13-16.
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Hepatitis can be caused by many different things including viral infections, parasites, bacteria, chemicals, autoimmunity, drugs or alcohol. Of these, viral infection is the most common cause of chronic (long-term) hepatitis, which can lead to severe liver damage including cirrhosis and liver cancer.
Hepatitis B and C viruses (HBV and HCV) are among the world’s most common infectious pathogens. It is estimated that 500 million people – 1 in 12 of the global population – are chronically infected with one or both of these viruses.1,2 The majority of these people live in the developing world and many of them are unaware that they are infected. Chronically infected patients are at increased risk of developing cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC), which together account for more than 1 million deaths annually.3
The hepatitis B virus is a resilient virus present in all bodily fluids of infected individuals. It is resistant to breakdown and able to survive outside the body. It can be transmitted effectively through contact with infected bodily fluids in the same way as HIV. However, HBV is 50–100 times more infectious than HIV.
The primary objective of therapy for chronic HBV is to achieve control of viral replication and halt disease progression/improve liver histology. This will decrease pathogenicity and infectivity and thereby stop or reduce hepatic necroinflammation.
Chronic hepatitis C infection may result in severe liver damage leading to liver failure, HCC and death. As a consequence, therapeutic intervention can arrest, and perhaps even reverse, the disease before irreversible liver damage occurs.
1. World Health Organization. World Health Organization Hepatitis B Fact Sheet. 1998.
2. World Hepatitis Alliance. www.aminumber12.org
3. Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003;362:2089–94
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