Hepatology

Hepatology is the branch of medicine that deals with diseases of the liver, gallbladder and biliary tract.

• Cirrhosis of the liver: degenerative disease of the liver caused by chronic inflammation resulting in irreversible changes in the structure and function of the organ.
• Acute and chronic viral liver infections: inflammation of the liver caused by infection by certain viruses that replicate mainly or exclusively in liver tissue (e.g., hepatitis A, B, C, and E viruses).
• Autoimmune diseases: autoimmune diseases with chronic and progressive inflammation of cells and tissues of the liver and bile ducts resulting in cell damage (necrosis) and scarring (fibrosis).
• Metabolic diseases: diseases caused by the absence/reduction in the activity of enzymes responsible for "breaking down" ingested food; unmetabolized nutrients accumulate in the body and intoxicate it.
• Rare diseases of the liver: e.g., primary biliary cholangitis, which consists of inflammation of the small bile ducts in the liver and, if left untreated, can lead to cirrhosis of the liver.
• Fatty liver disease (metabolic dysfunction associated fatty liver disease MAFLD): a chronic disease consisting of fat accumulation in the liver with inflammation and liver injury that impairs organ function.
• Alcoholic hepatopathitis: inflammatory process in the liver attributable to excessive and prolonged consumption of alcoholic beverages.
• Hepatocarcinoma: aggressive malignant tumor caused by uncontrolled development of liver tissue cells, often already affected by cirrhosis.
• Portal hypertension: excessively high blood pressure in the portal vein (the large-caliber vein that carries blood from the intestine to the liver) and its branches.
• Refractory ascites: a condition characterized by accumulation of free fluid in the peritoneal cavity; the most common cause is portal hypertension.

The liver is an organ that gives no signals
One usually discovers that one has liver disease when it is already in an advanced stage; in most cases this organ becomes diseased without giving any particular signals and, therefore, without one being aware of it; for this reason, the liver is said to be an asymptomatic organ.

Diagnosis

Diagnostic framing is done through:

• hepatologic examination;
• blood tests;
• abdominal ultrasound, Echo Doppler: to accurately diagnose biliary tract disorders and detect focal liver lesions;
• liver elastography: to know the degree of liver fibrosis and the amount of fat in the liver;
• percutaneous liver biopsies: examination that provides information about the histological structure of the liver and the presence of liver damage;
• hepatic venous pressure gradient (HVPG) measurement and transjugular liver biopsy: to diagnose the possible presence of portal hypertension.

Treatments

Treatment of liver disease involves:

• drug therapy according to the various cases (e.g., treatment of hepatitis B and C), surgery, and, in severe cases, liver transplantation; treatment goals are recovery of residual liver function and containment of complications and damage;
• prevention: vaccines are now available for hepatitis A and B, and many cases of hepatitis are preventable by avoiding the risk factors that cause the virus to spread;
• transjugular Intrahepatic Portosystemic Shunt (TIPS) is used to reduce hypertension of the portal vein, which is the vein responsible for transporting blood to the liver from most abdominal organs;
• automated low-flow ascites pump(Alfapump® System) or percutaneous drainage of refractory ascites: this is an implantable pump system that collects ascites as it forms and moves it to the bladder, where it is naturally expelled from the body through urination;
• treatment of decompensated cirrhosis (bleeding, ascites, jaundice, infection, renal failure);
• immunosuppressive treatment of patients after liver transplantation.

Diagnosis with state-of-the-art techniques

To perform liver elastography, EOC specialists use the Fibroscan®, an innovative diagnostic technique that uses ultrasound to learn the degree of fibrosis in the liver and, thus, define the presence and stage of liver disease and quantify liver fibrosis. Another procedure used to perform liver hepatography isAixplorer® ShearWave Elastography, a technique for assessing fibrosis using mechanical waves. Both procedures are noninvasive and avoid the need for biopsy.

The liver transplant

The center's specialists are responsible for the evaluation and management of patients in need of liver transplantation and subsequent follow-up.

Multidisciplinary boards

Multidisciplinary management ensures optimal care of the patient with liver-related diseases. For this reason, the EOC medical team engages in weekly collegial case discussions within multidisciplinary meetings. These include the multidisciplinary Histoboard to which interested medical personnel are allowed access upon authorization of the request for participation (for more information please contact the secretariat).

Histoboard

During the weekly Histoboard, biopsies taken during various diagnostic examinations are reviewed and discussed in collaboration with the Institute of Pathology EOC. This appointment is held using the Zoom platform and is also open to outside participants who can register in advance via e-mail.

Internships and master's work for medical students

Students in the Master of Medicine program of the Faculty of Biomedical Sciences at the Università della Svizzera Italiana (USI) can complete their program of study by working on their master's thesis in hepatology. Interested students can agree on the topic of their thesis with their thesis director or co-director.