Millions of Americans have liver disease, and those who do likely see a specialist called a hepatologist. Read here to learn if you should see one.

By: Said Nabhan, MD

When your tooth aches, you see a dentist. When your vision gets blurry, you visit an optometrist. And when you have trouble pooping, you schedule an appointment with a gastroenterologist.

But who do you see if you have a liver disorder? For that matter, how do you even know if you have a liver disorder?

Enter the hepatologist, commonly referred to as the liver doctor.

Meet our on staff hepatologist, Dr. Said Nebhan, here.

But a hepatologist treats much more than the liver. This highly specialized field within the broader practice of gastroenterology also focuses on conditions of the gall bladder, pancreas, and bile ducts. These body parts make up the biliary system, which produces the bile and enzymes that break down foods – an essential role in digestion.

Because of this overlap in body functions, you might wonder: When do I see a gastroenterologist, and when should I need a hepatologist? Let’s explore their differences.

Distinctions Between a Hepatologist and Gastroenterologist

All hepatologists are gastroenterologists, but not all gastroenterologists are hepatologists. Of the nearly 20,000 gastroenterologists in the United States, only about 7,300 are also hepatologists.

The key difference between the two fields is that gastroenterologists treat conditions of the entire digestive tract: the esophagus (food pipe), stomach, intestines, liver, bile ducts, gall bladder, and pancreas.

Hepatology is a subspecialty of gastroenterology but also considered a medical field of its own, focused specifically on disorders of the liver, gall bladder, pancreas, and bile ducts (hepatic organs). Hepatologists are generally referred to as liver specialists.

Both medical professions require extensive education of nearly 14 years. In addition to an undergraduate degree, a gastroenterologist must earn a four-year medical degree, a three-year residency in internal medicine, plus a three-year fellowship in a gastroenterology program.

Hepatology students follow a similar education passage, but their three-year gastroenterology fellowship includes the study of hepatology as a joint fellowship, or is followed by an advanced fellowship in hepatology.

Some gastrointestinal conditions can be treated by both specialists, but a hepatologist might be referred for specific liver-related ailments.

7 Conditions that a Hepatologist Treats

Your liver is your largest internal organ, so it deserves its own medical specialist. In addition to producing bile, the liver helps you digest food (fats, proteins, and carbohydrates), convert toxins into waste, and cleanses more than 250 gallons of blood every day.

In the United States, an estimated 1.8% of adults have been diagnosed with some type of liver disease.

Any of the following conditions could signal the need to see a hepatologist, and some can be treated by a hepatologist and gastroenterologist as a team.

Fatty liver disease – In some people, too much fat builds up in the liver cells. This can result from heavy alcohol consumption (alcoholic fatty liver disease) or certain metabolic conditions such as obesity, high cholesterol, or Type 2 diabetes (non-alcoholic fatty liver disease or NAFLD). A fatty liver presents few symptoms. However, if the liver becomes inflamed from NAFLD, it can develop into cirrhosis, so those at risk should get tested. Access more information about fatty liver here.

Cirrhosis – Should the liver be diseased or damaged over time, scar tissue forms. This compromised tissue cannot digest food, filter blood, and perform the other jobs healthy liver tissue does, and this can lead to complications such as jaundice, gall stones, and kidney failure. Symptoms include yellowing skin and eyes (jaundice), fatigue, and easy bleeding or bruising. Click to our liver cirrhosis web page here.

Hepatitis – This is a virus that causes inflammation that can lead to infection and liver damage. In the liver, the virus develops in two forms: Hepatitis B, a serious but usually short-term disease that your immune system fights off; and hepatitis C, a more common form of the virus that can be transmitted in your blood. Both infections can be acute (short-term) or chronic. Common symptoms are dark urine, grey-colored stools, fatigue, and jaundice. Learn more about hepatitis.

Liver cancer – Several conditions, including hepatitis and cirrhosis, can cause the cells in the liver to grow abnormally and uncontrollably, forming into an invasive tumor. Symptoms of liver cancer include a lump in the right side of the abdomen, abdominal pain, jaundice, weight loss, and fever. Read up on all gastrointestinal cancers on our web site.

Ascites – In patients with severe liver disease, fluid can build up between the layer of tissue surrounding the stomach and other organs in the abdomen. This results in a distended belly that feels full and swollen. Eight in 10 people with ascites suffer from cirrhosis. Other causes include pancreatic disease, heart failure, and cancer. Symptoms can range from shortness of breath and nausea to indigestion and heartburn.

Gall stones – The gall bladder stores bile, the fluid excreted from the liver to aid digestion. Sometimes cholesterol and other substances in the bile form into small crystals that can clog the small tubes that attach the gall bladder to the liver and to the intestines. Gall stones cause pain in the upper abdomen but also the right shoulder and back, as well as nausea and indigestion. Our gall stones web page explains more.

Pancreatitis – The pancreas secretes digestive juices (bile) into the small intestine and also controls blood sugar levels by making insulin. If a blockage such as gall stones occurs, the enzymes in the pancreas can cause it to digest itself, resulting in inflammation (pancreatitis). The condition is characterized by pain in the upper abdomen that radiates to the back and can worsen after eating, nausea, and diarrhea. Learn more symptoms of pancreatitis and how it is diagnosed here.

What to Expect If You Visit a Hepatologist

Should your doctor refer you a hepatologist, expect to undergo an examination that includes questions about your medical history, the prescribed drugs you take, and symptoms of illness. The hepatologist then might perform a number of diagnostic tests, including:

• Blood test – Blood can be drawn at the office to be medically examined.
• Stool test – You can bring a stool sample from home using a small kit provided by your doctor.
• Imaging – A range of X-rays, including a CT scan, FibroScan, ultrasound, and MRI, can provide a look at your insides to detect abnormalities, including inflammation.
• Endoscopy – The use of a slim, flexible tube or capsule to see inside the GI tract via a live camera that feeds images to the physician to examine.
• Liver biopsy – A sample of tissue taken from the liver that is microscopically examined for abnormalities and damage.

How to Find a Hepatologist

A hepatologist is a medical specialist that generally requires a referral from your general practitioner. You can likely find a hepatologist through various resources including WebMD and Healthgrades.

You also can find a liver specialist at your gastrointestinal practice. Cincinnati GI’s team of physician and care specialists includes me, a hepatologist that specializes in diseases of the liver.

To request an appointment, fill out our online form, which includes a place to list symptoms, here. You can read up on the liver-specific conditions we treat here.