Hepatology
As Hepatology a specialty is Gastroenterology denotes that the physiology and patho (physio) logy of the liver and biliary tract , as well as diagnosis and treatment of diseases of these organs comprises. It is not a separate subject. The term “hepatologist” usually stands for a gastroenterologist who specializes in liver diseases, but does not require any special training as a professional title in Germany.
Diseases of hepatology
In the case of congenital malformations , a distinction is made between anomalies of the liver and intrahepatic bile ducts including Caroli's syndrome , vascular anomalies and anomalies of the extrahepatic bile ducts.
Disturbances of the bilirubin metabolism , jaundice ( icterus ) and familial hyperbilirubinemia syndromes are classified
- in those with elevated indirect ("uncoupled") bilirubin
- Gilbert's syndrome , Crohn's Gilbert ( icterus intermittens juvenilis )
- Crigler-Najjar syndrome type I and II
- and those with elevated direct ("coupled") bilirubin
The inflammatory liver diseases are divided into viral infections ( hepatitis A , hepatitis B , hepatitis C , hepatitis D , hepatitis E and hepatitis G ), non-viral infections ( bacterial infections, infections by fungi and parasites such as amoeba - abscess , echinococcosis and liver fluke ), Granulomatous inflammation, autoimmune hepatitis and inflammation of the biliary tract ( cholangitis , primary biliary cirrhosis , primary sclerosing cholangitis , acute and chronic cholecystitis ).
A numerically large role gallstone sorrows of such toxic liver damage. B. from alcohol or medication and fatty liver . Liver fibrosis , liver cirrhosis and liver failure can occur as a result of various liver diseases . Metabolic disorders such as hemochromatosis , Wilson's disease ( hepatolenticular degeneration or copper storage disease), alpha-1 antitrypsin deficiency , glycogenoses and porphyrias are less common .
Among the malignant neoplasms of the liver, liver metastases are the most common, hepatocellular carcinoma , bile duct carcinoma , cystadenocarcinoma and hepatoblastoma are rather rare.
In childhood neonatal icterus and congenital bile duct changes play a role . a. Byler syndrome ( Progressive familial intrahepatic cholestasis ), Alagille syndrome and Reye syndrome , the greatest roles in pregnancy, acute pregnancy fat liver and acute pregnancy cholestasis .
Investigation methods
Laboratory values
- Bilirubin : direct, indirect
- Excretion of bilirubin in the urine
- AST (formerly: GOT), ALT (formerly: GPT), GLDH : these three enzymes are components of the liver cells and are increasingly measurable when they are damaged, for example in viral hepatitis . GOT and GPT are collectively referred to as transaminases .
- CHE, Quick value or INR and albumin are dependent on factors that are formed in the liver and are therefore used to assess liver synthesis performance.
- Hepatitis serology if an infectious event is suspected and to assess the activity of a known infection .
- γ-GT , AP : these enzymes are contained in the biliary tract and are accordingly released more frequently if they are damaged (for example in the case of an inflammation of the biliary tract). Together they are also referred to as cholestasis parameters .
- Iron , ferritin , copper and ceruloplasmin levels in suspected iron or copper metabolism disorders such as hemochromatosis and Wilson's disease
Imaging procedures
for the representation of the tissue architecture as well as any space requirements
biopsy
A liver biopsy is an invasive procedure to remove tissue from the liver with or without ultrasound guidance. The microscopic tissue architecture ( histology ) is then examined .
Treatment methods of hepatology
- Diet (see hepatic encephalopathy )
-
Viral hepatitis
- Vaccination against hepatitis A and B.
- Antivirals and interferons for viral hepatitis B or C.
- Ursodeoxycholic acid when bile acids build up in the body ( cholestasis )
- Increase in pressure in the portal vein circulation
- Transplant as a last resort
Hepatologies in Europe
swell
- Herold: Internal Medicine , 2001
- Böcker, Denk, Heitz: Pathology , Urban and Fischer