It was my first month in the hospital as a new intern in internal medicine at a large university clinic. Local residents I met during orientation asked me, “What is your first rotation?” When I replied, “Hepatology,” the looks I received in response told me that I was facing a difficult initiation.
The hepatology service included some of the sickest patients in the hospital. Everyone had either terminal cirrhosis or a liver transplant and an acute illness that required them to be hospitalized. They were so complicated and made the newly minted Dr. Evans realized that a healthy liver is critical to the normal functioning of the body.
Cirrhosis of the liver (scarring of the liver) is the undesirable result of many types of chronic liver disease. Many causes of liver disease occur randomly and are related to autoimmune diseases or genetic causes. However, the most common reasons for developing cirrhosis of the liver are alcohol-related liver disease, hepatitis C, and non-alcoholic fatty liver disease, all of which can be controlled if we catch them before cirrhosis develops.
Most people know that chronically heavy alcohol consumption can lead to cirrhosis. We don’t fully understand why some heavy drinkers develop cirrhosis and others don’t, but longstanding alcohol abuse usually leads to some degree of liver damage. While it can be very difficult, stopping alcohol can, in turn, stop the progression of liver damage in most patients with alcohol-related liver disease.
Hepatitis C, a viral infection that becomes chronic in some people and can ultimately lead to cirrhosis of the liver, has been the most common cause of liver transplantation in the United States in recent years. With the major developments in the treatment of this disease over the past decade, we now have highly effective and well-tolerated antiviral treatments for curing hepatitis C. This virus can reside in the liver and bloodstream without causing symptoms for decades. Current recommendations recommend that we look for patients at significant risk for hepatitis C, including all Americans born between 1945 and 1965, as well as other high-risk populations. Speak to your doctor if this is your part.
Non-alcoholic fatty liver disease (NAFLD) is on the rise and is one of the most common causes of liver failure today. It is believed that NAFLD is due to metabolic factors that lead to fat deposition in the liver. It often occurs with other metabolic diseases such as obesity, diabetes, and high cholesterol. Treatment for NAFLD focuses on diet and exercise, as well as controlling these other metabolic disorders.
That one month as a new doctor in the hepatology department was instructive. I have learned so much about the importance of a healthy liver and I continue to use these lessons regularly in primary care.
Kelly Evans-Hullinger, MD is part of the Prairie Doc® medical team and currently practices internal medicine in Brookings, South Dakota. Visit www.prairiedoc.org for free and easy access to the entire Prairie Doc® library and follow Prairie Doc® on Facebook. On-demand with the Prairie Doc®, a medical Q&A show will be shown, which is streamed centrally on most Thursdays at 7:00 p.m.