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Hepatology is the branch of medicine that incorporates the study of liver,gallbladder,biliary tree,and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology,rapid expansion has led in some countries to doctors specializing solely on this area,who are called hepatologists.
Alcoholic liver disease (ALD), also called alcohol-related liver disease (ARLD),is a term that encompasses the liver manifestations of alcohol overconsumption,including fatty liver,alcoholic hepatitis,and chronic hepatitis with liver fibrosis or cirrhosis.
Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure,although availability of donor organs is a major limitation. The most common technique is orthotopic transplantation,in which the native liver is removed and replaced by the donor organ in the same anatomic position as the original liver. The surgical procedure is complex,requiring careful harvest of the donor organ and meticulous implantation into the recipient. Liver transplantation is highly regulated,and only performed at designated transplant medical centers by highly trained transplant physicians and supporting medical team. Favorable outcomes require careful screening for eligible recipients,as well as a well-calibrated live or deceased donor match.
Autoimmune hepatitis,formerly known as lupoid hepatitis,plasma cell hepatitis,or autoimmune chronic active hepatitis,is a chronic,autoimmune disease of the liver that occurs when the body's immune system attacks liver cells,causing the liver to be inflamed. Common initial symptoms may include fatigue,nausea,muscle aches,or weight loss or signs of acute liver inflammation including fever,jaundice,and right upper quadrant abdominal pain. Individuals with autoimmune hepatitis often have no initial symptoms and the disease may be detected by abnormal liver function tests and increased protein levels during routine bloodwork or the observation of an abnormal-looking liver during abdominal surgery.
Biliary atresia,also known as extrahepatic ductopenia and progressive obliterative cholangiopathy,is a childhood disease of the liver in which one or more bile ducts are abnormally narrow,blocked,or absent. It can be congenital or acquired. It has an incidence of one in 10,000–15,000 live births in the United States,and a prevalence of one in 16,700 in the British Isles. Biliary atresia is most common in East Asia,with a frequency of one in 5,000.
Primary biliary cholangitis (PBC),previously known as primary biliary cirrhosis,is an autoimmune disease of the liver. It results from a slow,progressive destruction of the small bile ducts of the liver,causing bile and other toxins to build up in the liver,a condition called cholestasis. Further slow damage to the liver tissue can lead to scarring,fibrosis,and eventually cirrhosis.
Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts,which normally allow bile to drain from the gallbladder. Affected individuals may have no symptoms or may experience signs and symptoms of liver disease,such as yellow discoloration of the skin and eyes,itching,and abdominal pain.
Ursodeoxycholic acid (UDCA),also known as ursodiol,is a secondary bile acid,produced in humans and most other species from metabolism by intestinal bacteria. It is synthesized in the liver in some species,and was first identified in bile of bears of genus Ursus,from which its name derived. In purified form,it has been used to treat or prevent several diseases of the liver or bile ducts.
Alagille syndrome (ALGS) is a genetic disorder that affects primarily the liver and the heart. Problems associated with the disorder generally become evident in infancy or early childhood. The disorder is inherited in an autosomal dominant pattern,and the estimated prevalence of Alagille syndrome is 1 in every 30,000 to 1 in every 40,000 live births. It is named after the French pediatrician Daniel Alagille,who first described the condition in 1969. Children with Alagille syndrome live to the age of 18 in about 90% of the cases.
Cholestasis is a condition where the flow of bile from the liver to the duodenum is impaired. The two basic distinctions are:
Neonatal cholestasis refers to elevated levels of conjugated bilirubin identified in newborn infants within the first few months of life. Conjugated hyperbilirubinemia is clinically defined as >20% of total serum bilirubin or conjugated bilirubin concentration greater than 1.0 mg/dL regardless of total serum bilirubin concentration. The differential diagnosis for neonatal cholestasis can vary extensively. However,the underlying disease pathology is caused by improper transport and/or defects in excretion of bile from hepatocytes leading to an accumulation of conjugated bilirubin in the body. Generally,symptoms associated with neonatal cholestasis can vary based on the underlying cause of the disease. However,most infants affected will present with jaundice,scleral icterus,failure to thrive,acholic or pale stools,and dark urine.
A hepatoportoenterostomy or Kasai portoenterostomy is a surgical treatment performed on infants with Type IVb choledochal cyst and biliary atresia to allow for bile drainage. In these infants,the bile is not able to drain normally from the small bile ducts within the liver into the larger bile ducts that connect to the gall bladder and small intestine.
Children's Liver Disease Foundation (CLDF) is a UK charity taking action against the effects of childhood liver disease,providing information,emotional support,research funds and a voice for all affected.
Liver cancer,also known as hepatic cancer,primary hepatic cancer,or primary hepatic malignancy,is cancer that starts in the liver. Liver cancer can be primary in which the cancer starts in the liver,or it can be liver metastasis,or secondary,in which the cancer spreads from elsewhere in the body to the liver. Liver metastasis is the more common of the two liver cancers. Instances of liver cancer are increasing globally.
Ischemic hepatitis,also known as shock liver,is a condition defined as an acute liver injury caused by insufficient blood flow to the liver. The decreased blood flow (perfusion) to the liver is usually due to shock or low blood pressure. However,local causes involving the hepatic artery that supplies oxygen to the liver,such as a blood clot in the hepatic artery,can also cause ischemic hepatitis.
Liver kidney microsomal type 1 antibody (anti-LKM1) is an autoantibody associated with autoimmune hepatitis (AIH). Specifically,its presence in AIH defines type 2 AIH,although it has been proposed that anti-liver cytosol type 1 autoantibody without detectable anti-LKM1 can be seen in type 2 AIH. It is one of the several subtypes of anti–liver-kidney microsome antibodies that are known. The frequent association of anti-LKM-1 antibodies and hepatitis C virus (HCV) infections and the probable existence of an infection-associated autoimmune form of anti-LKM-1-associated hepatitis,requiring a different therapeutic strategy,necessitate the exact determination of anti-LKM-1 specificities.
Cirrhosis,also known as liver cirrhosis or hepatic cirrhosis,and end-stage liver disease,is a condition of the liver in which the normal functioning tissue,or parenchyma,is replaced with scar tissue (fibrosis) and regenerative nodules as a result of chronic liver disease. Damage to the liver leads to repair of liver tissue and subsequent formation of scar tissue. Over time,scar tissue and nodules of regenerating hepatocytes can replace the parenchyma,causing increased resistance to blood flow in the liver's capillaries—the hepatic sinusoids—and consequently portal hypertension,as well as impairment in other aspects of liver function. The disease typically develops slowly over months or years.
Thomas D. Schiano is an American specialist in liver transplantation,intestinal transplantation and in the diagnosis and treatment of acute and chronic liver disease. He serves as associate editor for the journals Hepatology and Liver Transplantation and has published more than 200 peer-reviewed articles and abstracts and more than 20 book chapters.
James Michael Millis is an American academic and surgeon specializing in pediatric and adult liver transplantation. He is Professor of Surgery and Vice Chair of Global Surgery at University of Chicago. He is also the director of Clinical Leadership Development Fellowship and Hepatobiliary Surgery at the University of Chicago Medical Center. He is known for developing new techniques of liver surgery that improved outcomes following liver transplantation and non transplant liver and biliary tract surgery.
Alexander Parker Mowat was a Scottish paediatric hepatologist. He established the paediatric hepatology unit at King's College Hospital,London,which became a referral centre for children across Britain with liver diseases.
References
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- 1 2 "| Non-Executive Directors – NHS Blood and Transplant (VAC-1678)".
- 1 2 "Deirdre Kelly". scholar.google.com.
- ↑ "The Transplantation Society". www.tts.org.
- ↑ "Public Affairs Committee | ESPGHAN". www.espghan.org.
- ↑ "Professor Deirdre Kelly CBE DL | West Midlands Lieutenancy".
- ↑ Hartley, Jane L.; Davenport, Mark; Kelly, Deirdre A. (14 November 2009). "Biliary atresia". Lancet. 374 (9702): 1704–1713. doi:10.1016/S0140-6736(09)60946-6. PMID 19914515. S2CID 24191796 – via PubMed.
- ↑ McKiernan, P. J.; Baker, A. J.; Kelly, D. A. (1 January 2000). "The frequency and outcome of biliary atresia in the UK and Ireland". Lancet. 355 (9197): 25–29. doi:10.1016/S0140-6736(99)03492-3. PMID 10615887. S2CID 25981400 – via PubMed.
- ↑ Davenport, Mark; De Ville de Goyet, J.; Stringer, M. D.; Mieli-Vergani, G.; Kelly, D. A.; McClean, P.; Spitz, L. (24 April 2004). "Seamless management of biliary atresia in England and Wales (1999–2002)". Lancet. 363 (9418): 1354–1357. doi:10.1016/S0140-6736(04)16045-5. PMID 15110492. S2CID 24198964 – via PubMed.
- ↑ Verkade, Henkjan J.; Bezerra, Jorge A.; Davenport, Mark; Schreiber, Richard A.; Mieli-Vergani, Georgina; Hulscher, Jan B.; Sokol, Ronald J.; Kelly, Deirdre A.; Ure, Benno; Whitington, Peter F.; Samyn, Marianne; Petersen, Claus (17 September 2016). "Biliary atresia and other cholestatic childhood diseases: Advances and future challenges". Journal of Hepatology. 65 (3): 631–642. doi:10.1016/j.jhep.2016.04.032. PMID 27164551. S2CID 206131565 – via PubMed.
- ↑ Mieli-Vergani, Giorgina; Heller, Solange; Jara, Paloma; Vergani, Diego; Chang, Mei-Hwei; Fujisawa, Tomoo; González-Peralta, Regino P.; Kelly, Deirdre; Mohan, Neelam; Shah, Uzma; Murray, Karen F. (17 August 2009). "Autoimmune hepatitis". Journal of Pediatric Gastroenterology and Nutrition. 49 (2): 158–164. doi: 10.1097/MPG.0b013e3181a1c265 . PMID 19561543. S2CID 5931393.
- ↑ Chai, Pei Fan; Lee, Way Seah; Brown, Rachel M.; McPartland, Jo L.; Foster, Katharine; McKiernan, Patrick J.; Kelly, Deirdre A. (17 March 2010). "Childhood autoimmune liver disease: indications and outcome of liver transplantation". Journal of Pediatric Gastroenterology and Nutrition. 50 (3): 295–302. doi: 10.1097/MPG.0b013e3181bf0ef7 . PMID 20118802. S2CID 44562401.
- ↑ Murray, Karen F.; Hadzic, Nedim; Wirth, Stefan; Bassett, Mikelle; Kelly, Deirdre (17 October 2008). "Drug-related hepatotoxicity and acute liver failure". Journal of Pediatric Gastroenterology and Nutrition. 47 (4): 395–405. doi: 10.1097/MPG.0b013e3181709464 . PMID 18852631.
- ↑ Kelly, D. A. (1 November 2002). "Managing liver failure". Postgraduate Medical Journal. 78 (925): 660–667. doi:10.1136/pmj.78.925.660. PMC 1742542 . PMID 12496321 – via pmj.bmj.com.
- ↑ Evans, Helen M.; Kelly, Deirdre A.; McKiernan, Patrick J.; Hübscher, Stefan (3 May 2006). "Progressive histological damage in liver allografts following pediatric liver transplantation". Hepatology. 43 (5): 1109–1117. doi: 10.1002/hep.21152 . PMID 16628633. S2CID 22266576.
- ↑ "Liver transplantation in children".
- ↑ Beath, S. V.; Brook, G. D.; Kelly, D. A.; Cash, A. J.; McMaster, P.; Mayer, A. D.; Buckels, J. A. (2 October 1993). "Successful liver transplantation in babies under 1 year". British Medical Journal. 307 (6908): 825–828. doi:10.1136/bmj.307.6908.825. PMC 1678855 . PMID 8401122 – via www.bmj.com.
- ↑ Kelly, D.; Jara, P.; Rodeck, B.; Lykavieris, P.; Burdelski, M.; Becker, M.; Gridelli, B.; Boillot, O.; Manzanares, J.; Reding, R. (2004). "Tacrolimus and steroids versus ciclosporin microemulsion, steroids, and azathioprine in children undergoing liver transplantation: randomised European multicentre trial". Lancet. 364 (9439): 1054–1061. doi:10.1016/S0140-6736(04)17060-8. PMID 15380964. S2CID 7835608.
- ↑ "The Lunar Medal".
- ↑ "Virtual IPTA 2022 – Virtual". virtual.ipta2022.org.
- ↑ "Non-executive director appointments at Guy's and St Thomas'". NHS. 26 April 2023. Retrieved 9 September 2024.
- ↑ Dayani, Alison (5 July 2010). "Your Celebrations: A happy 21st to city's pioneering transplant unit". BirminghamLive.
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