What does a hepatologist treat? What does a hepatologist treat? Hepatology - branch of medicine that studies the liver, gallbladder, biliary tract

And the biliary system. it is necessary to have a perfect knowledge of anatomy, normal and pathological physiology hepatobiliary tract, age-related features that may affect the development of the disease in a patient.

An important direction in the professional activity of a hepatologist is preventive work. He develops treatment tactics, but at the same time acquaints the patient with the necessary measures that will improve his condition and prevent decompensation of the pathological process.

This may be planning a daily regimen, dietary recommendations, spa treatment. The hepatologist evaluates the general state of health and, if necessary, refers the patient to a consultation with specialists in related fields, both therapeutic and surgical.

Hepatology is usually a secondary specialization. This means that the doctor has already acquired a medical specialty and has undergone further training, which allows him to navigate in several areas at the same time.

The infectious disease specialist-hepatologist has extensive knowledge regarding the etiology, pathogenesis and treatment viral lesions liver, and a gastroenterologist-hepatologist deals with combined pathologies of the hepatobiliary system and the gastrointestinal tract.

Given that therapy and pediatrics are differentiated due to the many anatomical and physiological differences between adults and children, a pediatric hepatologist consults with a child's liver disease.

Indications for consultation

What does a hepatologist treat? Patients with a variety of chronic pathologies of the hepatobiliary system, acquired or genetically inherited, turn to him. The list includes diseases such as:

1. Hepatitis (inflammation of the liver tissue).
   Hepatitis is classified primarily on an etiological basis. Viral hepatitis comes first in terms of prevalence, followed by toxic (provoked by household and industrial poisons, drugs, alcohol) and autoimmune (due to the aggression of the immune system against tissues). own body). Acute viral hepatitis is treated by an infectious disease specialist. The prerogative of the hepatologist is to confirm the diagnosis and stage of chronic hepatitis, search for the cause, choose the method of therapy, correct it during treatment and evaluate the effectiveness of the result, as well as prevent complications.
2. Cirrhosis (excessive production of fibrous tissue and its replacement of functioning hepatocytes - liver cells).
   The cirrhotic process is triggered as a result of damage and necrosis of hepatocytes, has a chronic course. Occurs as a result of hepatitis, severe hypoxia ( oxygen starvation) and shock.
3. Alcoholic liver disease.
   This is a combined pathology, including chronic hepatitis and cirrhosis of the liver.
4. Storage diseases affecting the liver.
   These are dyslipoproteinemia, mucopolysaccharidoses, glycogenosis, due to which an excess amount of any substance is deposited in the liver.
5. hereditary pathologies.
   These include Gilbert's syndrome, or familial non-hemolytic jaundice, Wilson-Konovalov's disease, or hepatocerebral dystrophy.
6. Diseases of the gallbladder and biliary tract.
   Among them are cholecystitis and cholangitis. various etiologies, including .

Symptoms that require consultation with a hepatologist

In addition to already diagnosed diseases, the patient can consult a hepatologist based on the appearance of such symptoms:

In the case of chronic inflammation of the liver or biliary tract, the symptoms are not presented in isolation, although any of them may dominate.

Consultation with a hepatologist will help to understand the nature of their appearance. If the detected pathology is not included in the range of professional tasks, the hepatologist will refer the patient to the right specialist.

Hepatologist appointment

A hepatologist treats chronic diseases, which implies the need for several consultations. First, the doctor asks about complaints, collects an anamnesis, conducts general inspection, after which he appoints a number of laboratory and instrumental research which will clarify the picture of the disease.

If necessary, temporarily prescribes symptomatic drugs. The final treatment option is chosen only after a comprehensive examination.

You can ask a hepatologist a question for free on many medical sites on the net. But the advice received is not a substitute for a full-fledged consultation. To fully understand the problem, the doctor needs an internal examination, as well as the opportunity to ask the patient in detail about complaints and symptoms.

Due to the fact that the liver and biliary apparatus are involved in the process of digestion, hepatology has always been a branch of gastroenterology - the science of the digestive organs. As a separate specialty, hepatology stood out about 60 years ago, thanks to the British professor Sheila Sherlock, who managed to open the first department of hepatology in the world.

You don't become a hepatologist right away. Hepatology is an additional advanced training course for doctors who, by virtue of their specialty, are related to liver diseases.

Among hepatologists, there are the following narrow specialists:

• pediatric hepatologist- a doctor who is familiar with the characteristics of the liver in children and usually deals with congenital diseases of the liver and biliary tract;
• infectiologist-hepatologist ( hepatologist-virologist) - a doctor who diagnoses and treats infectious diseases of the liver;
• hepatologist-gastroenterologist- a doctor who treats diseases of the gastrointestinal tract and has deep knowledge in the field of hepatology;
• hepatologist surgeon is a general surgeon who performs operations on the liver;
• hepatologist-oncologist- a doctor who treats liver tumors.

What does a hepatologist do?

Hepatitis viruses are:

• Enteral ( intestinal) - the virus enters the body through the intestines with food and dirty hands. Enteral hepatitis includes viral hepatitis A and E. They are usually observed in children, often do not have clear symptoms and tend to be chronic.
• Parenteral ( bypassing the intestines) - the virus enters directly into the blood medical procedures, sexual contact and from mother to fetus. These hepatitis include viral hepatitis B, C and D, which usually occur as a chronic infection.
• Mixed hepatitis (mixed) - occurs when two hepatitis viruses are present ( B+C, B+D). Infection with the second virus can occur simultaneously with the first ( coinfection) or against the background of an existing infection ( superinfection).

alcoholic liver disease

Alcoholic liver disease has the following forms:

• Alcoholic hepatomegaly is an enlargement of the liver due to increased load on hepatocytes ( liver cells). This condition occurs when there is a lack of the enzyme alcohol dehydrogenase, which triggers the formation of carbon dioxide and water from alcohol. Occurs in 20% of lesions alcohol disease liver.
• Alcoholic fatty liver ( fatty liver or steatosis) - this is the accumulation of fatty acids in hepatocytes due to the fact that the liver directs all its enzymes to process alcohol and does not have time to process fats. Occurs in 60 - 75% of patients with alcoholism.
• alcoholic hepatitis ( alcoholic steatohepatitis) - is an acute or chronic inflammation of the liver ( with cell destruction) caused by alcohol intoxication. It is observed in 35% of cases.
• Alcoholic fibrosis of the liver - it is an overgrowth of the scar connective tissue in the liver, which begins to tighten the lobules and break natural structure (architectonics) liver. This condition occurs due to the ability of ethanol ( alcohol) to stimulate the growth of fibrous tissue. Rarely seen ( 10% of cases).
• Alcoholic cirrhosis of the liver- cirrhosis of the liver, occurring 10 to 20 years after the onset of alcohol abuse. Alcoholic cirrhosis accounts for 50% of all cases of liver cirrhosis.
• Hepatocellular carcinoma - a malignant tumor of the liver that develops against the background of alcoholism.

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease has the following forms:

• steatosis - formation of fatty deposits in the liver different sizes (small- or large-drop obesity);
• nonalcoholic steatohepatitis - is a combination of fatty liver and liver inflammation ( hepatitis A).

autoimmune hepatitis

It is believed that the cause of the disease is a violation in the immune regulation system. Autoimmune hepatitis often co-occurs with other autoimmune diseases ( thyroid disease, glomerulonephritis, myocarditis, ulcerative colitis and others).

Drug-induced liver injury

Drug-induced liver injury can occur in the following cases:

• direct drug damage to liver cells ( this property of drugs is called hepatotoxicity);
• allergic reaction for the drug
• violation of biological processes in the liver, in which the drug "intervenes".

The most common causes of drug-induced hepatitis are:

• non-steroidal anti-inflammatory drugs- paracetamol, aspirin, ibuprofen, diclofenac;
• antibiotics- tetracycline, erythromycin, co-trimoxazole ( biseptol), rifampicin, isoniazid, ciprofloxacin, amoxiclav, trimethoprim, sulfamethoxazole;
• antifungal drugs- ketoconazole, fluconazole;
• immunosuppressants and cytostatics- methotrexate, azathioprine;
• cardiac drugs- captopril, enalapril, cordarone, verapamil, losartan;
• hormonal preparations - anabolic steroids ( retabolil), estrogens, birth control pills, corticosteroids;
• psychotropic drugs- chlorpromazine, amitriptyline;
• cholesterol lowering agents- atoris, rosucard, tulip and others.

Toxic damage to the liver

Thus, toxic hepatitis May be occupational disease, flow in the form acute poisoning or testify to bad ecology ( metal pollution, radiation).

Cirrhosis of the liver

Primary biliary cirrhosis of the liver

Primary biliary cirrhosis differs from secondary in the absence of pathology of the gallbladder and large bile ducts.

portal hypertension

The causes of portal hypertension syndrome may be:

• obstruction of blood flow in the vein itself- thrombus, tumor of the abdominal cavity;
• compression of its small branches in the liver- fibrosis, cirrhosis, tumor, abscess or cyst of the liver;
• violation of the outflow of blood from the liver through the hepatic veins- thrombosis, defects in the development of the hepatic veins, compression by the tumor, high pressure in the right heart ( cardiomyopathy, valvular disease, pericarditis).

Liver failure

According to the rate of occurrence, liver failure can be acute ( within a few weeks) and chronic ( develops slowly).

The cause of liver failure can be:

• damage to liver cells and their destruction;
• violation of blood flow inside the liver;
• extrahepatic causes ( in violation of the function of other organs).

The most pronounced manifestations of liver failure are:

• hepatic encephalopathy- this is a combination of symptoms of a malfunction of the central nervous system, which occurs due to the fact that the liver ceases to neutralize toxic products ( ammonia), and they begin to affect the brain;
• hepatic coma- this is the absence of consciousness and reflexes to stimuli ( is extreme hepatic encephalopathy).

Bacterial liver abscesses

Echinococcus eggs, getting along with contaminated food into the stomach and intestines of a person, are absorbed into the venous system of the portal vein and are brought into the liver by blood flow. There, most of them are retained, while one is formed in the liver. large cyst (unilocular or cystic echinococcosis) or many echinococcal cysts ( alveococcosis) containing echinococci.

Sexually mature individuals of the worm live in the small intestine. They can penetrate into the biliary tract, gallbladder and further into the liver from the duodenum.

Hemochromatosis can be:

• hereditary ( idiopathic, primary) - as a result genetic disorders metabolism in the intestine absorbed a lot of iron;
• secondary ( acquired) - occurs when the body receives a lot of iron ( nutritional features, blood transfusion, with acquired diseases of the liver and pancreas).

Pigmentary hepatoses

These diseases are characterized by chronic or recurrent jaundice in the absence of macroscopic ( visible to the eye) changes in the structure of the liver and biliary tract, as well as obvious phenomena of stagnation of bile or hemolysis ( breakdown of red blood cells, in which a lot of free bilirubin is released from them).

Pigmentary hepatosis includes:

• Gilbert's syndrome;
• Crigler-Najjar syndrome;
• Dubin-Johnson syndrome;
• Rotor syndrome.

Wilson's disease

"Free" copper has a toxic effect on the liver, causing the development of fibrosis and inflammation in the liver, with a gradual transformation into cirrhosis. Wilson's disease proceeds as chronic active hepatitis, can manifest itself at any age, but more often for the first time makes itself felt in adolescence.

Cholelithiasis

Stones can form from cholesterol or from bilirubin. In most cases, the stones have a mixed structure. With a sufficient content of calcium in the stones, they are visible on the X-ray.

Gallstone disease has the following stages:

• Stage of biliary sludge. Biliary sludge is thick, heterogeneous bile in the gallbladder, consisting of cholesterol crystals, bilirubin granules, and calcium salts. Sludge is detected by ultrasound ( ultrasound) and indicates the possibility of stone formation.
• Asymptomatic stage. At this stage, there are already stones in the gallbladder or ducts, but they do not cause complaints ( asymptomatic lithiasis).
• Stage of clinical manifestations. At this stage, the stones cause a violation of the outflow of bile and / or inflammation of the biliary tract.

Biliary dyskinesia

Biliary dyskinesia has two forms:

• Hypertensive dyskinesia- the tone of the gallbladder and bile ducts is increased, there is a spasm of the sphincter of Oddi or Lutkens. As a result, the rhythm of gallbladder emptying is disturbed ( it is quickly emptied and becomes "small" due to constant spasm).
• Hypotonic dyskinesia- the tone of the gallbladder and ducts is lowered, and their contraction is weakened, which leads to a "flabby" state of the gallbladder, the size of which after contraction almost does not decrease.

Cholecystitis

Cholecystitis is considered chronic if its symptoms last more than 6 months.

Cholangitis

Among cholangitis, primary sclerosing cholangitis occupies a special place - a disease with a hereditary predisposition, in which inflammation and fibrosis are observed ( scarring) bile ducts, which eventually lead to cirrhosis of the liver.

Tumors of the liver and biliary tract

Benign tumors of the liver may not manifest themselves in any way or, squeezing the vessels of the liver, cause the development of portal hypertension. With tumor of the vessel ( hemangioma) there is a risk of its rupture.

Tumors of the biliary tract cause the development of obstructive jaundice due to the closure of the lumen of the bile ducts.

A special place is occupied by liver cysts, which can be single or multiple ( polycystic liver).

What symptoms are most often referred to a hepatologist?

Symptoms that should be referred to a hepatologist

A hepatologist is a leading specialist in the field of medicine that affects diseases associated with the liver. In addition to the presented organ, the area of ​​​​the gallbladder and biliary tract is studied by a specialist. In addition to adult hepatology, there is also children's hepatology, which has appeared quite recently as an independent field of medicine. What does a hepatologist do, in more detail.

List of diseases treated by a hepatologist

Liver diseases very often proceed without any characteristic symptoms, especially at the initial stage of development of the process. That is why many people make late appointments with a specialist such as a hepatologist. There is only one way to avoid this - periodically undergo a complete check-up of the body or come for a consultation to the specified doctor.

The list of the diseases that he treats is quite extensive, given that his area includes the functions of not only the liver, but also the biliary tract and bladder. So, it should be noted hepatitis, cirrhosis of the liver, alcoholic liver disease, herpetic hepatitis, toxoplasmosis. This list also includes such forms of hepatitis that were provoked by the influence of Gram-negative bacteria.

It is equally important to pay attention to the ability of the hepatologist to supervise the following conditions: legionnaires' disease, cholelithiasis, yellow fever, Various types hepatitis and even yellow fever. Less common, but nevertheless relevant, should be considered Gilbert's disease, hemochromatosis, mononucleosis, cholangitis and some other diseases.

In particular, we can talk about a non-specific form reactive hepatitis.

Thus, it is obvious that the field of activity of a hepatologist is quite extensive, and therefore further I would like to pay attention to what are the features of the examination.

Features of the examination by a hepatologist

A consultation with a hepatologist begins with asking the patient about what symptoms bother him and whether there are any additional complaints about general well-being. In a separate order, the doctor considers hereditary factor, namely the predisposition to certain liver diseases based on their presence in blood close relatives. In addition, the hepatologist must take into account other features of the condition: lifestyle, the presence of certain bad habits.

Based on the results of the conversation with the patient, certain studies are assigned. First of all, I would like to draw attention to some tests, namely the general and biochemical analysis of blood and urine. The presented analyzes, on the basis of which the hepatologist treats his patients, are basic, that is, mandatory for determining the key problems associated with the liver.

In order to determine other features of the condition, it is necessary to pay attention to other diagnostic methods. In particular, we are talking about ultrasound, other laboratory-type studies, including radiological ones. It is with the help of the presented diagnostic measures that the hepatologist receives the most complete information, which allows him to prescribe a further recovery course.

However, I would like to draw attention to a number of studies that are assigned quite rarely, but are also part of the diagnosis before the start of the recovery process. In particular, we are talking about the analysis of feces with the identification of stercobilin in it, a blood test for the presence of erythrocytes and reticulocytes there. The following laboratory tests are also carried out, on the basis of which the specialist successfully treats his patients:

1. analysis for the presence of herpes virus infection;
2. liver biopsy - performed using local anesthesia and involves hospitalization for a certain number of hours;
3. electroencephalography.

In a situation where there is a suspicion of the presence of a viral form of hepatitis E, a urine and blood test is carried out for the presence of hemoglobin in the list of their components.

Symptoms of diseases and their treatment

The implementation of the recovery process in liver diseases is subject to several categories of principles. First of all, it may be necessary to complex treatment, which is focused on the fight against pathogens of a particular disease. Speech in this case we are talking about antiviral therapy, which in the vast majority of cases is characterized by a high degree of effectiveness.

Further, the hepatologist may indicate the need to implement some additional measures in terms of treatment. In this case, it is necessary to take into account the presence of certain chronic diseases in the patient. In the vast majority of cases, this applies to diseases of the urinary system, cardiovascular and respiratory. They are the factor that generally weakens the body and negatively affects the activity of the liver.

Next healing principle could be diet. Most often, diet No. 5 is prescribed, however, in some cases, certain principles related to nutrition are selected separately. Thus, it is extremely important that the hepatologist receives the most complete information about the condition of the patient, what his vitals are. important indicators. An equally important aspect should be considered the main symptoms, which should also be known to the doctor.

Most often, conditions such as cirrhosis of the liver and hepatitis C are formed. Given their high prevalence, I would like to dwell on what symptoms are associated with them. Speaking of cirrhosis, experts pay attention to the weak severity of symptoms at the initial stage of the disease. Further, as the condition develops, bleeding gums, pain in the abdomen and an increase in its size may occur.

The general mood and condition of the patient begins to change most dramatically, so lethargy and even drowsiness appear.

The hepatologist, of course, will pay attention to a decrease in sexual desire and a change in the shade of the skin, which turns out to be yellowish. In addition, the color of the feces becomes discolored, there is a significant darkening of the urine. In order to avoid such rapidly progressive changes, it is necessary to consult a doctor as soon as possible in order to exclude any of the stages of acute cirrhosis of the liver.

Hepatitis C is a much more insidious disease because it does not have any characteristic symptoms. The development of a condition from an acute form to a chronic one can be called hidden and this process can continue for 15-20 years or more. Because of this, patients may not even know that they have encountered hepatitis C, because over time they get used to those symptoms that once seemed strange and unusual to them.

This is about painful sensations in the abdomen, weakness, weight loss and appetite. Itching, certain manifestations on the skin can form. With hepatitis C, damage can occur not only to the liver, but also to other internal organs, in particular, blood, the endocrine system, kidneys and nervous system. This is far from a complete list, because it directly depends on concomitant chronic diseases, as well as the age and other characteristics of the patient's state of health.

Considering all this, it is safe to say that the hepatologist is doing a great job. The field of activity of the presented doctor is quite extensive - it covers not only the liver, but also some other internal organs. That is why the main task of the doctor, in this case, is to make a diagnosis and identify therapeutic measures based on it.

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1. Can cancer be prevented?
The occurrence of a disease such as cancer depends on many factors. No one can be completely safe. But significantly reduce the chances of occurrence malignant tumor everyone can.

2. How does smoking affect the development of cancer?
Absolutely, categorically ban yourself from smoking. This truth is already tired of everyone. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of cancer deaths. In Russia, lung tumors kill more people than tumors of all other organs.
Eliminating tobacco from your life is the best prevention. Even if you smoke not a pack a day, but only half, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3. Does it affect excess weight to the development of cancer?
Keep your eyes on the scales! Overweight affect not only the waist. The American Institute for Cancer Research has found that obesity contributes to the development of tumors in the esophagus, kidneys, and gallbladder. The fact is that adipose tissue serves not only to save energy reserves, it also has a secretory function: fat produces proteins that affect the development of a chronic inflammatory process in the body. And oncological diseases just appear against the background of inflammation. In Russia, 26% of all cancer cases are associated with obesity.

4. Does exercise help reduce the risk of cancer?
Set aside at least half an hour a week for exercise. Sport is on the same level as proper nutrition when it comes to cancer prevention. In the US, one third of all deaths associated with the fact that patients did not follow any diet and did not pay attention to physical education. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but more vigorously. However, a study published in the journal Nutrition and Cancer in 2010 proves that even 30 minutes is enough to reduce the risk of breast cancer (which affects one in eight women in the world) by 35%.

5.How does alcohol affect cancer cells?
Less alcohol! Alcohol is blamed for causing tumors in the mouth, larynx, liver, rectum, and mammary glands. Ethanol decomposes in the body to acetaldehyde, which then, under the action of enzymes, passes into acetic acid. Acetaldehyde is the strongest carcinogen. Alcohol is especially harmful to women, as it stimulates the production of estrogen - hormones that affect the growth of breast tissue. Excess estrogen leads to the formation of breast tumors, which means that every extra sip of alcohol increases the risk of getting sick.

6. Which cabbage helps fight cancer?
Love broccoli. Vegetables are not only included in healthy diet They also help fight cancer. This is also why recommendations for healthy eating contain the rule: half daily ration should be fruits and vegetables. Especially useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: ordinary white cabbage, Brussels sprouts and broccoli.

7. Which organ cancer is affected by red meat?
The more vegetables you eat, the less red meat you put on your plate. Studies have confirmed that people who eat more than 500 grams of red meat per week have a higher risk of developing colon cancer.

8. Which of the proposed remedies protect against skin cancer?
Stock up on sunscreen! Women aged 18-36 are particularly susceptible to melanoma, the deadliest form of skin cancer. In Russia, in just 10 years, the incidence of melanoma has increased by 26%, world statistics show an even greater increase. Both artificial tanning equipment and the sun's rays are blamed for this. The danger can be minimized with a simple tube of sunscreen. A study published in the Journal of Clinical Oncology in 2010 confirmed that people who regularly apply a special cream get melanoma half as often as those who neglect such cosmetics.
The cream should be chosen with a protection factor SPF 15, apply it even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also do not expose yourself to the sun's rays from 10 to 16 hours.

9. Do you think stress affects the development of cancer?
By itself, stress does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Research has shown that constant anxiety changes the activity of immune cells responsible for turning on the “hit and run” mechanism. As a result, a large amount of cortisol, monocytes and neutrophils, which are responsible for inflammatory processes, constantly circulate in the blood. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.

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What is the competence of a Hepatologist

What diseases does a Hepatologist deal with?

What organs does a Hepatologist deal with?

When to See a Hepatologist

The course of the disease goes through several stages. And depending on the stage, symptoms appear. In the initial stage, the symptoms are almost invisible. But still, you can pay attention to them. The sooner treatment begins, the more likely it is to completely restore the liver and keep its tissues viable. This organ has a high ability to regenerate (recovery).

So the symptoms.

The patient has bleeding gums, an increase in the volume of the stomach, abdominal pains appear, human behavior changes (concentration of attention decreases, fatigue, drowsiness). The patient has a decrease sex drive often in men there is an increase in the mammary glands. Skin color becomes yellowish.
The color of feces changes - it can be light, the color of urine changes - it becomes dark (like beer). If you pay attention to one of the symptoms in time, the treatment will stop further development cirrhosis of the liver.

Hepatitis C Symptoms

Most patients are symptom-free. The development of hepatitis and the transition from acute to chronic are hidden for many years (up to 25 years), when a person may not even suspect that he is infected with hepatitis C.

But, when symptoms are present, the most common complaints are weakness, abdominal pain, poor appetite, weight loss, and itching. skin manifestations. Hepatitis C can be manifested by damage not only to the liver, but also to many body systems (endocrine system, blood system, skin, eyes, joints and muscles, nervous system, kidneys, blood vessels).
The pathogenesis of alcoholic liver disease

There are the following direct and indirect effects of ethanol on the liver, underlying alcoholic liver damage:

Disorganization of cell membrane lipids, leading to adaptive changes in their structure;
- damaging effect of acetaldehyde;
- violation of the neutralizing function of the liver in relation to exogenous toxins;
- violation of immune responses;
- increase in collagenogenesis;
- stimulation of carcinogenesis.

When and what tests should be done

What are the main types of diagnostics usually performed by a Hepatologist

Let him rest more, do not load him with heavy physical work, in no case should he lift weights (this can lead to gastrointestinal bleeding).

It is important that the patient had regular stools - 2 times a day. Every day you need to monitor the amount of fluid you drink and excrete. If too much urine is excreted, it is necessary to notify the attending physician immediately. Measure the patient's weight and abdominal volume daily. If an increase in weight and volume is noticeable, this indicates that fluid retention is increasing in the body. Notify your doctor of these changes as well.

Prevention of hepatitis

To protect yourself from infection with hepatitis, you must follow simple rules.

You should not drink unboiled water, always wash fruits and vegetables, and do not neglect the heat treatment of food. In this way, you can prevent infection with hepatitis A, the transmission of which is associated with contamination of food with the faeces of a sick person. The great rule "Wash your hands before eating" is a guarantee of health in this case too.

In general, contact with other people's body fluids should be avoided. For protection against hepatitis B and C - primarily with blood.

In microscopic quantities, blood can remain on razors, toothbrushes, nail scissors. Do not share these items with other people.

IN medical institutions take measures to prevent infection with hepatitis.

However, if you had an endoscopy or dental treatment ten or fifteen years ago, when the fight against hepatitis was not yet carefully organized, you need to get checked. There is still a small risk of infection today.

Never share syringes and needles. Never use non-sterile piercings and tattoos. Remember - the hepatitis virus is very tenacious and, in contrast to the AIDS virus, it persists in the external environment for a long time (sometimes up to several weeks!).

Hepatitis B is most commonly transmitted sexually, but hepatitis C can also be transmitted. Particular care must be taken when having sex during menstruation and anal intercourse, but oral sex can also be dangerous.

Hepatitis is also transmitted by the so-called "vertical" way - from mother to child during pregnancy, childbirth, during breastfeeding. With proper medical support, you can try to avoid infection of the baby - this will require careful adherence to hygiene rules and medication.

However, the route of infection with hepatitis very often remains unknown. To be completely calm, it is necessary to vaccinate.

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A hepatologist is a specialist in the field of medicine that diagnoses and treats various diseases organ of the liver. Actually, on the basis of this, one can understand who a hepatologist is, what he treats, and approximately what problems should be addressed to him. Meanwhile, such an explanation is not so detailed, and therefore below we will consider all those points that are in one way or another connected with the activities of a hepatologist in order to understand what specifically focuses on the specifics of his activity.

Hepatology, as a field of medicine, is a branch of gastroenterology focused on the study of the above area (that is, the liver, gallbladder, bile ducts). By the way, there is also children's hepatology, singled out as a separate section of hepatology relatively recently. Pediatric hepatology deals with the study of the characteristics of the liver in terms of its structure and development, and, as is clear, in this case we are talking about young patients.

What diseases does a hepatologist treat?

Before we move on to a specific list of diseases to which the hepatologist is directly involved, we note that for the most part, liver diseases are quite serious, and their treatment is often lengthy. With this in mind, to cure the patient will need to make a lot of efforts, seriously approaching the treatment prescribed by the hepatologist, including the diet, which is also one of the main directions of such treatment. In addition to diagnosing, treating and developing specific directions for the prevention of liver diseases, the hepatologist is also involved in the implementation of these measures in relation to the biliary tract and gallbladder.

Among the diseases treated by this doctor are the following:

• hepatitis (acute and chronic form of the course of the disease);
• cirrhosis of the liver;
• alcoholic liver disease;
• herpetic hepatitis;
• toxoplasmosis;
• hepatitis caused by exposure to gram-negative bacteria;
• legionnaires' disease;
• cholelithiasis;
• cytomegalic hepatitis;
• non-alcoholic steatohepatitis;
• yellow fever;
• enteroviral hepatitis;
• autoimmune hepatitis;
• toxic hepatitis;
• hepatitis C;
• Gilbert's disease (Gilbert's syndrome);
• hemochromatosis;
• Infectious mononucleosis;
• cholangitis;
• leptospirosis;
• asthenovegetative syndrome;
• nonspecific form of reactive hepatitis, etc.

If a patient has liver cancer, the hepatologist refers him to an oncologist. Identification of a different type of gastrointestinal diseases determines the need for a subsequent examination by a gastroenterologist.

Reception of a hepatologist: how is it?

A consultation with a hepatologist as part of his appointment consists in asking the patient about current complaints and manifestations of symptoms. The issue of heredity (predisposition to certain liver diseases based on the presence of those in the next of kin) is also considered separately. Of course, the lifestyle and typical preferences of the patient are taken into account, the impact of which in many cases plays a major role in the occurrence of a particular disease.

Tests ordered by a hepatologist

Based on general data, as well as to reinforce the proposed diagnosis, the hepatologist can prescribe the following main research options for the subsequent specification of the patient's condition:

• general blood test;
• biochemical blood test;
• Analysis of urine.

In addition to these research options, which, as the reader may notice, are standard regardless of which doctor the patients turn to, there may be certain additions to this effect. As such, ultrasonic and laboratory research, radiological diagnostic methods can also be used. Due to these research options, information on the patient's condition is obtained more complete, which, accordingly, contributes to the establishment of a specific disease and the stage of its course.

Additional studies ordered by a hepatologist

However, this list is not all. Select a series additional research, which may also be appointed by the specialist in question:

• analysis of feces for the content of stercobilin in it;
• a blood test for the content of erythrocytes and reticulocytes in it;
• Ultrasound of the liver, CT ( CT scan), MRI (magnetic resonance imaging);
• analysis for the presence of herpes infection (Epstein-Barr virus, cytomegalovirus, herpes simplex virus);
• liver biopsy (this research method is performed using local anesthesia, followed by hospitalization lasting several hours);
• electroencephalography;
• in case of suspicion of the relevance of viral hepatitis E, urine and blood are examined for the level of hemoglobin in their composition.

Treatment prescribed by a hepatologist

The basic principles of treatment prescribed by a hepatologist boil down to the following main points:

• complex treatment focused on eliminating the causative agent of a particular disease, in other words, it is antiviral therapy;
• implementation of additional treatment measures, which take into account the presence of a different type of chronic diseases in the patient (in particular, these can be diseases of the urinary system, diseases of the cardiovascular system, respiratory system etc.);
• diet (diet No. 5 is mainly prescribed, in some cases the principles of the diet can be developed individually).

Symptoms that should be referred to a hepatologist

In this case, we will consider the most common liver diseases, and, accordingly, the symptoms indicating these diseases, thus stopping at cirrhosis of the liver and hepatitis C.

Cirrhosis of the liver: symptoms

This disease proceeds in several main stages, according to these stages, symptoms of cirrhosis of the liver appear. So, the initial stage is characterized by the insignificance of the manifestation of symptoms, although there are certain manifestations that are important to pay attention to. With cirrhosis of the liver, as with other diseases, the earlier the patient seeks medical assistance and begins the prescribed treatment, the greater the chances of subsequently achieving a complete recovery of the liver organ while maintaining the viability of its tissues. We also note that the liver, with an appropriate approach and within the framework of the reversible stage of the course of the disease, is characterized by a fairly high degree of ability for its own regeneration, in other words, for self-healing.

Let's get back to the symptoms. These include bleeding gums, abdominal pain, while the stomach itself begins to gradually increase in volume. The mood of patients is also subject to changes, in particular, this is reflected in the ability to concentrate, as well as in the appearance of drowsiness and fatigue. A sick person experiences problems with sexual desire (it decreases accordingly), the skin acquires a yellowish tint. Changes are noted in the color of the feces, which often becomes light, and urine changes, acquiring a color similar to kvass / beer (that is, it darkens). We repeat that the timely allocation of these symptoms and the adoption of appropriate measures by the patient, in the future, allows you to stop the development of cirrhosis of the liver.

Hepatitis C: symptoms

In this case, the disease is more insidious, because for the most part its course is accompanied by the practical absence of any specific symptoms. The development of hepatitis C, as well as its subsequent transition from an acute form to a chronic form, occurs in a hidden way, and this can last up to 25 years. Within such a period, patients, accordingly, may not even assume that they are infected with this disease.

If symptoms do occur, they are most often in the form of abdominal pain, weakness, weight loss, and appetite. Itching occurs, characteristic skin manifestations appear. It should be noted that hepatitis C manifests itself in some cases not only in the form of damage to the liver, but also to other body systems. In particular, this is the blood system, endocrine system, muscles and joints, blood vessels, kidneys, nervous system, etc.

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What diseases does a hepatologist treat?

The hepatologist treats:

• Hepatitis of viral origin (hepatitis A, B, C, D and E), occurring in acute and chronic form. Hepatitis A and E are spreading fecal-oral route(enter the body as a result of drinking contaminated water or food), usually proceed benignly (hepatitis E is unfavorable for women in the last trimester of pregnancy). Hepatitis A, which accounts for 40% of all acute viral hepatitis, does not become chronic and does not lead to permanent liver damage. In addition, antibodies are formed to this type of virus. Hepatitis E is recorded mainly in countries with a hot climate. Hepatitis B, C and D are transmitted in most cases through parenteral contact with virus-infected blood, semen and other body fluids (blood transfusion, contaminated medical instruments, etc.). Hepatitis B can also be transmitted household way or during childbirth from mother to child. The acute form is accompanied by signs of general intoxication of the body and impaired liver function, and the chronic form is often characterized by an asymptomatic course.
• Cirrhosis of the liver. Is irreversible chronic disease, at which normal tissue liver (parenchymal) is replaced by connective tissue. The disease is accompanied by hardening of the liver, its increase or decrease, weakness, dyspeptic disorders, weight loss, fever, pain in the joints and in the upper abdomen. Cirrhosis can be alcoholic, viral, congestive or primary biliary (develops as a result of genetic disorders of immunoregulation).
• Herpetic hepatitis, which is most often observed in newborns and in immunocompromised children. The disease is caused by the herpes simplex virus (it has several serotypes), which the child becomes infected with during fetal development or during childbirth. Liver damage is observed with a generalized form of herpes infection in newborns. The disease develops on the 5-10th day of life and is accompanied by high temperature, lethargy, intoxication, enlargement of the liver and spleen, vomiting, hemorrhagic syndrome, respiratory failure. Jaundice is also often observed, depression of consciousness and convulsions are possible. A severe form of the disease causes severe cholestasis (stagnation in the liver of bile components), acute hepatic encephalopathy and liver failure.
• Alcoholic liver disease, which develops with prolonged use of alcohol, which has a direct hepatotoxic effect. The first (reversible) stage of the disease is steatosis - fatty infiltration of the liver, in most cases asymptomatic. In the second stage of the disease, the patient develops inflammation of the liver (alcoholic hepatitis), and last stage is cirrhosis. The development of the disease in men leads to the use of 40-80 g of pure ethanol per day, and in women - more than 20 g.
• Cytomegalic hepatitis, which causes cytomegalovirus, which has a tropism (orientation) to epithelial tissues. The virus belongs to the family of herpesviruses, which are able to stay in the body in a latent state for a long time. It spreads by airborne droplets and sexually, with blood during blood transfusions, with saliva, urine and breast milk, as well as vertically (penetrates through the placental barrier and when passing through the birth canal). In adults, the virus is activated during immunosuppressive therapy. Congenital cytomegalic hepatitis in newborns and in children of the first years of life may be accompanied by severe pneumonia, reactive erythroblastosis, hemorrhagic syndrome and jaundice, and in older children, jaundice and hepatosplenomegaly are observed to a moderate degree. The anicteric form of the disease is characterized by poor symptoms and satisfactory condition the child, and the icteric form can proceed in a favorable and unfavorable form. An unfavorable form of cytomegalic hepatitis is observed with the development of obliterating cholangitis and the subsequent formation of biliary cirrhosis.
• Non-alcoholic steatohepatitis (fatty liver), which is different histological features alcoholic liver damage in the absence of alcohol abuse. There is an inflammatory infiltration of the parenchyma and stroma of the liver and the presence of focal necrosis. The disease can be primary and secondary. The primary form is the hepatic manifestation metabolic syndrome, which is associated with a violation of insulin resistance (observed with obesity, diabetes, dyslipidemia). The secondary form of the disease is associated with damage to mitochondria, impaired cellular respiration and disturbed process of β-oxidation of fatty acids. Liver damage of this kind provokes the intake of certain drugs (glucocorticoids, estrogens, etc.), malabsorption syndrome, sudden weight loss, cystic fibrosis, parenteral nutrition during long period, Niemann-Pick disease, etc.
• Hepatitis caused by Coxsackie A and B viruses. The leading place in the clinical picture of the disease is occupied by general (flu-like) manifestations enterovirus infection, and hepatomegaly, deviation of functional tests and jaundice in a number of patients is a consequence of the involvement of the liver in the pathological process.
• Autoimmune hepatitis, in which progressive inflammatory-necrotic liver damage is associated with the presence of antibodies in the blood serum that target the liver (the liver is destroyed immune system organism). The reasons for the development of the disease have not been fully established. Provoking factors include the measles virus, Epstein-Barr virus, hepatitis A, B, C, and taking certain medications (Interferon, etc.). There are three main forms of the disease, which differ in the clinical picture and methods of therapy. The disease develops suddenly Clinical signs consistent with the symptoms of acute hepatitis.
• Toxic hepatitis is an acute or chronic liver disease that develops when drugs, chemicals, fungal toxins enter the body as a result of toxic action these substances on liver cells. The disease is accompanied by an increase in the liver, the appearance of pain in the right hypochondrium and jaundice. May be acute and chronic. The acute form is associated with a single exposure to a poison in a large concentration or a small dose. poisonous substance subject to the affinity of this substance to the liver cells (symptoms appear after 2-5 days). The chronic form is caused by repeated ingestion of small doses of a toxic substance that does not have affinity for liver cells (symptoms appear after a long period of time).
• Reactive hepatitis (nonspecific form, secondary hepatitis) is a reaction of the liver tissue that occurs with extrahepatic disease. These liver lesions of an inflammatory-dystrophic nature develop in diseases of the gastrointestinal tract, severe infectious diseases, intoxication, connective tissue diseases, etc. The cause of reactive hepatitis are toxins that are produced in the presence of various pathological processes in the body. Toxins gradually cause inflammatory-dystrophic changes in liver cells and dysfunction of the organ.

If liver cancer is detected, the patient is referred to an oncologist, in the presence of other diseases of the gastrointestinal tract - to a gastroenterologist.

When to See a Hepatologist

A hepatologist is needed for people who:

• there is yellowing of the skin, whites of the eyes, mucous membranes;
• elevated levels of hepatic transaminases ALT and AST or bilirubin in the blood;
• ultrasound diagnostics revealed changes in the liver;
• there was a feeling of heaviness in the right hypochondrium or pain;
• there is a violation of appetite, a constant feeling of bitterness in the mouth, heartburn and nausea are often observed, vomiting occurs;
• spicy and fatty foods, as well as alcohol, provoke deterioration;
• Urine is dark and/or stool is light (greyish-white) in color
• an itchy rash of unknown origin or vascular "asterisks" appeared;
• there is pain in the joints.

A hepatologist is also necessary for people who have had contacts with a patient with viral hepatitis A (to monitor their health).

Stages of a medical consultation

Hepatologist during consultation:

• clarifies the patient's complaints and studies the anamnesis;
• examines the patient (including palpation of the liver area);
• examines the results of previous studies and, if necessary, appoints additional examination;
• makes a diagnosis, develops an individual treatment regimen and recommends a wellness program.

Diagnostics

To make a diagnosis, the hepatologist directs the patient to:

• blood tests (general and biochemical);
• general urine analysis;
• Ultrasound of the liver, gallbladder, pancreas.

Also, if additional examination is necessary, the hepatologist prescribes:

• coprogram - analysis of feces, which allows to determine the amount of stercobilin (tetrapyrrole bile pigment, which is formed during the processing of bilirubin);
• CT and MRI of the liver and biliary tract;
• analysis for the presence of herpes infection (ELISA and PCR), which allows to detect cytomegalovirus, Epstein-Barr virus and herpes simplex virus;
• liver biopsy (used local anesthesia, hospitalization is indicated for several hours);
• electroencephalography (indicated for suspected severe viral hepatitis);
• analysis of urine and blood for hemoglobin levels in case of suspected hepatitis E.

If necessary, esophagoscopy, hormonal and radioisotope studies are also carried out, specific analyzes blood (FibroMax, Fibrotest), which allow you to assess the condition of the liver tissue.

If hepatitis or chronic inflammatory diseases liver, the hepatologist directs the patient to elastometry - a non-invasive study that allows you to assess the degree of liver fibrosis (the degree of fibrosis is the main indicator of the severity of the disease). For this examination, the Fibroscan apparatus is used.

Treatment Methods

Since liver cells are affected in any viral hepatitis, the disease with different pathogens proceeds according to a similar scenario. In this regard, the treatment of viral hepatitis is carried out according to general principle. Patients with an acute form of hepatitis are hospitalized in a hospital, with a mild and moderate form, half-bed rest is indicated, and with a severe form, bed rest.

A hepatologist prescribes enterosorbents (microcrystalline or hydrolytic cellulose, etc.) to unload the liver, to improve general condition and liver function - multivitamins. Perhaps the appointment of enzyme preparations that improve digestion. In severe viral hepatitis, blood plasma proteins and blood substitutes are administered.

With viral hepatitis A and E with acute course diseases and almost always a favorable prognosis, antiviral agents are not prescribed in most cases, and for other types of viral hepatitis, the use of antiviral agents (synthetic nucleosides or interferons) is indicated.

Treatment of chronic viral hepatitis is based on continuity, complexity and individual selection of treatment regimens.

Treatment of cirrhosis is aimed at stopping or slowing the progression of the disease and improving the quality of life.

Drug treatment depends on the cause of cirrhosis:

• If cirrhosis is a consequence of viral hepatitis B or C, antiviral therapy is prescribed, which suppresses the activity of the virus and has an antifibrotic and anticirrhotic effect.
• If cirrhosis has developed as a result of alcoholic liver disease, hepatoprotectors are prescribed, which allow complete failure from alcohol to stop the progression of cirrhosis and reduce the degree of fibrosis.
• If cirrhosis develops due to metabolic syndrome or non-alcoholic fatty liver disease, hormonal imbalances are corrected, which, in combination with diet, increased physical activity and the use of hepatoprotectors, antioxidants and insulin sensitizers, can lead to the regression of fibrosis and recovery of the liver.

Decompensated liver cirrhosis in some cases requires endoscopic and surgical treatment. Save the patient's life terminal stage cirrhosis is possible only with the help of transplantation.

With cholelithiasis, conservative treatment and surgical treatment are possible. At conservative therapy(possible with a stone diameter of up to 2 cm) shock wave lithotripsy, bile acid preparations are used. Surgical treatment includes laparoscopic cholecystectomy, laparoscopic cholecystolithotomy, and removal of the gallbladder.

The hepatologist also selects a diet for the patient for any liver damage (usually diet No. 5 is prescribed) and rehabilitation treatment.

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When should I go to see a hepatologist?

We list the symptoms of common liver diseases, the occurrence of which requires a visit to a hepatologist. It is important to always remember that timely appeal a consultation can save a person's health and life, because the liver is an organ that, with proper treatment, is restored and continues to function. Therefore, it is important to turn to a hepatologist on time yourself, and to have time to send a loved one to him for an appointment.

Symptoms of viral hepatitis C, for example, can be: loss of appetite, abdominal pain, itchy skin, rashes or other abnormal skin manifestations, weakness, weight loss.

Cirrhosis of the liver is manifested by an increase in the abdomen, abdominal pain, a change in behavior - drowsiness is often felt, fatigue appears, and attentiveness decreases. In addition, hepatologists say that there may be bleeding gums, deterioration of libido, breast enlargement in men.

Common to cirrhosis and other liver diseases may be such signs: darkening of urine, lightening of feces, yellowing of the skin and eyeballs.

Contacting a hepatologist about at least one of the listed symptoms can help to identify the disease in time.

How does a hepatologist diagnose?

A hepatologist's consultation involves examining the patient, familiarizing himself with the symptoms and prescribing such studies:

• General blood analysis;
• Study of the exchange of iron, copper;
• Coagulogram;
• PCR blood test: qualitative and quantitative test for HCVRNA and HBVDNA (hepatitis B and C), qualitative test for HDVRNA (hepatitis D);
• Biochemical blood test to determine the level of total and direct bilirubin, sodium, potassium, protein, albumin, glucose, cholinesterase, alkaline phosphatase, ALT, GGT, AST;
• Study of hepatitis B and C markers by ELISA;
• The study of the level of AFP - a marker of tumor pathologies of the liver;
• The study of autoantibodies.

Also, reviews of hepatologists confirm that, in addition to blood tests, the following types of examinations can be prescribed:

• Colonoscopy - examination of the large intestine using a special device;
• Computed, magnetic resonance imaging (CT and MRI) of organs that are in the abdominal cavity;
• Esophagoscopy (abbreviated as EGDS) is an examination of the esophagus. During the study, they take biological material to test it for the presence of the bacterium H. Pylori (Helicobacter pylori).

Very often, a hepatologist uses ultrasound data of the abdominal organs.

How to choose a hepatologist

Contrary to the already established stereotypes, it does not matter whether the hepatologist works in a public or private clinic. The difference can only be in the payment for the appointment of a hepatologist and the examinations that he will appoint.

Most importantly, when choosing a specialist, do not forget to look for reviews about hepatologists. In the case of a disease of such an organ as the liver, a good hepatologist-diagnostician is needed, who is able to carry out differential diagnostics and select a sparing treatment.

When choosing a hepatologist, pay attention to his personal statistics - to the percentage of successfully cured patients.

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What is a hepatologist?

A hepatologist is a doctor who deals with the problems of the hepatobiliary system, consisting of:

• Liver;
• Gallbladder;
• bile ducts.

Every disease functional impairment and a failure in the mechanism of their work is the subject of study of the hepatologist. He is able to diagnose and prescribe the required treatment, but all this is impossible without extensive knowledge in the anatomy of the hepatobiliary tract, in understanding the physiology of the normal and pathological capacity of its structures, as well as the symptoms, and the influence of provoking factors and age-related changes on the progression of the disease.

It is this doctor who should conduct explanatory work with patients so that they are aware of what the prevention of hepatological diseases looks like, what has a negative effect on the liver, and how to prevent poisoning of the body.

Liver problems can have a different nature of origin, occur in an acute or chronic form, have similar and hallmarks, but the consequence to which they lead is one thing - damage to the organ and intoxication of the body.

We do not dwell on the definition of who a hepatologist is and what he treats, so we will further understand what his duties are.

For the patient with complaints, diagnostics should be carried out. It includes a conversation with a hepatologist and examination. The specialist probes and taps the area of ​​​​the liver to draw a conclusion regarding its size, the presence of a painful symptom and the presence of fluid in the cavity.

If hepatological diseases are suspected, laboratory diagnostics is prescribed, based on:

• On a general blood test, where, in the presence of inflammation, the level of leukocytes will be increased, anemia is possible;
• On a biochemical blood test, in order to determine the amount of bilirubin, cholesterol and protein components;
• On a blood test for hepatitis, to clarify its type, etc.

In addition, it is widely used in hepatology instrumental diagnostics, in particular:

• Ultrasound of the liver and biliary tract;
• X-ray test, using contrast agents;
• duodenoscopy;
• Laparoscopy;
• Cholangiography (transhepatic and percutaneous);
• Magnetic resonance imaging;
• CT scan.

Based on all these results, a diagnosis is made, after which a treatment plan is drawn up. The hepatologist should be well-versed in the pharmacological issues of the effects of drugs, because in case of liver disease they can have a detrimental effect on the affected cells.

Most often, patients with this type of disease come to the hepatologist with the main symptom - pain in the right hypochondrium. They note that fried foods and the use of fatty foods lead to its strengthening.

Character pain can be completely different, which corresponds to a certain type of disease.

• Cirrhosis, hepatitis and biliary dyskinesia are characterized by aching and bursting pain;
• For cholelithiasis - acute and paroxysmal discomfort.

In addition, the patient notes nausea, vomiting, flatulence and a bitter taste in the mouth. Yellowness of the skin and eye proteins indicates existing problems in the work of hepatobiliary structures.

TO general symptoms can be attributed to the fact that people with liver damage lose a lot of weight, and weaken mentally and physically.

For their treatment, conservative and surgical methods of treatment can be used. Preparations for the liver should contain non-toxic components, and improve cell metabolism, as well as activate recovery processes in the hepatological organ system.

Operable manipulations in modern medicine are moving to a low-traumatic level, because laparoscopy, puncture and drainage are increasingly being used.

First of all, the condition and functioning of the liver, like any other internal organs, is affected by what we eat. Right now eating right has become very fashionable, but this is one of the few “popular habits” that will benefit you. You need to carefully control your diet and completely eliminate from it fried food and fats. But in nature, there are correct and necessary fatty acids, which are found in vegetable oils (olive, linseed, sesame), in non-roasted nuts, sea fish and seafood. Never forget about them.

As for carbohydrates, their excessive consumption can also do harm. By focusing on cereals, vegetables and fruits, you can be calm about the health of your liver.

Alcohol is a slow-acting poison for the body. Excessive enthusiasm for them will lead to the gradual destruction of the whole organism. So limit yourself to rare glasses of good wine.

Uncontrolled and prolonged use of drugs will not cure you, but on the contrary, will destroy you. It is necessary to take drugs strictly according to the doctor's prescription, and following all his recommendations in terms of the treatment course and dosage.

And do not forget to lead an active lifestyle, otherwise internal processes are also inhibited, which is extremely negative.

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To make an appointment with a doctor

Select your city and your area to find the best hepatologist.

When to contact

A doctor should be consulted when the following symptoms are observed:

• discomfort, heaviness, pain in the upper right side of the abdomen, as well as in the right hypochondrium;
• nausea and vomiting, heartburn;
• bitterness in the mouth and loss of appetite;
• skin itching and rashes on the skin;
• jaundice skin and yellowing of the white of the eye;
• an increase in the size of the liver and spleen;
• an increase in the size of the abdomen due to the accumulation of fluid in the abdominal cavity;
• dark urine and light grayish stools.

As soon as these symptoms appear, you should consult a doctor. It should be borne in mind that for a long time many liver diseases can be asymptomatic, so when they appear, it is quite possible that the disease is already in a neglected state. Naturally, it is necessary to be regularly observed by a hepatologist if liver diseases have already been diagnosed.

A hepatologist treats the following diseases:

• all types of hepatitis in chronic and acute form;
• cholelithiasis;
• cirrhosis of the liver;
• hemochromatosis (pathology of iron metabolism);
• toxoplasmosis;
• yellow fever;
• infectious mononucleosis;
• legionnaires' disease;
• cholangitis;
• cholecystitis;
• fatty hepatosis of the liver;
• Gilbert's syndrome.

After examinations and if a suspicion of oncology is detected, the hepatologist sends the patient for examination to an oncologist. If other diseases of the gastrointestinal tract are detected, then the examination should continue with a gastroenterologist.

How to prepare for your visit

No special preparation is required to visit a hepatologist. Please bring your blood tests, if any, and a referral from your doctor. general practice if it exists too.

What will the doctor do at the appointment

During the consultation, the hepatologist will listen and record complaints, analyze the symptoms. Of great importance is the epidemiological history:

• whether there was contact with blood;
• when blood and its preparations were transfused;
• When was the last surgery?
• when you visited a dentist, beautician;
• whether the patient applied tattoos and when it was.

The doctor conducts a general clinical examination, palpates (i.e., probes) the abdomen, determines the size of the liver and spleen. He will ask about hereditary diseases, will also take an interest in your lifestyle and diet. Treatment and additional examination are prescribed by the hepatologist individually. Having collected all the tests and studies, the doctor may prescribe:

• complex treatment and antiviral therapy;
• additional treatment of concomitant chronic diseases;
• diet number 5 or individual diet.

The hepatologist also prescribes such modern and effective procedures as:

• infusion therapy (introduction of therapeutic solutions into the bloodstream);
• plasmapheresis (removal of blood plasma to cleanse the body);
• ozone therapy;
• laser irradiation of blood.

A consultation with a hepatologist is an opportunity to promptly:

• learn about your personal risks of developing liver diseases and their effective prevention;
• determine treatment;
• determine the need for vaccination.

Vaccination is primarily needed:

• people by the nature of their work who are constantly in contact with blood (doctors, laboratory assistants, police officers and employees of the Ministry of Emergency Situations, patients with frequent blood transfusions, drug addicts);
• military personnel;
• people who in the near future will go to areas that are unfavorable for hepatitis;
• people caring for patients with hepatitis.

What examinations and tests can a hepatologist prescribe

Additionally, the doctor may prescribe the following studies:

• Ultrasound, CT, MRI of the abdominal cavity;
• general and biochemical blood tests and OAM, a detailed coagulogram is prescribed;
• analysis for viral hepatitis;
• PCR, ELISA to detect viral infections;
• if necessary, a liver biopsy;
• echoencephalography.

Tests are ordered to identify:

• stercobilin content in feces;
• cholesterol levels;
• alkaline phosphatase activity;
• the number of reticulocytes and erythrocytes in the blood;
• herpesvirus infection (HSV of both types, cytomegalovirus, Epstein-Barr);
• with suspicion of viral hepatitis, the level of hemoglobin in the blood and in the urine is determined.

Prices in Moscow for the first consultation

The cost of the first consultation in Moscow with a hepatologist starts from 1100 rubles and depends on the level and size of the clinic and the degree of qualification of the specialist.

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