24 - Hepatology

Abstract

The liver plays important roles in detoxification, production of bile, energy storage and protein synthesis. The liver and biliary tree are affected by a diverse range of pathologies commonly encountered in medical and surgical practice. Abnormalities of liver enzymes are extremely common in the general population and require careful interpretation to identify significant liver disease. Acute liver failure is a medical emergency that requires specialist assessment and intensive management. The liver can also be affected by a wide range of chronic viral, metabolic and autoimmune diseases which can lead to progressive liver fibrosis and cirrhosis. This can present with the consequences of liver failure, portal hypertension and hepatocellular carcinoma. Alcohol-related liver disease continues to impose a significant burden on healthcare systems, while the prevalence of non-alcoholic fatty liver disease is steadily increasing. The past decade has shown dramatic changes in the treatment of viral hepatitis with effective antiviral treatment for hepatitis B and C. There have also been more incremental advances in our understanding and management of hepatobiliary disease including primary biliary cholangitis, IgG4 disease, hepatobiliary malignancy and functional biliary disease. This chapter will discuss the presentation, diagnosis and management of a range of liver and biliary diseases. The role of liver transplant in the management of acute and chronic liver failure and hepatocellular cancer is reviewed.