Hepatology
The liver is one of the body’s most important metabolic and detoxifying organs. Many liver diseases may cause few or non-specific symptoms for a long time. As a result, the first abnormality is often detected during a routine laboratory test or abdominal ultrasound examination.
At the SanBer Medical hepatology clinic, we provide comprehensive assessment, specialist evaluation, treatment and long-term management of liver diseases.
We place particular emphasis on the assessment and follow-up of fatty liver disease, persistent or unexplained liver enzyme abnormalities, chronic liver diseases and autoimmune or immune-mediated diseases of the liver and bile ducts.
The diagnostic process may include laboratory tests, an abdominal ultrasound or a FibroTouch examination. If an autoimmune condition is suspected, assessment at our immunology clinic may also be recommended. Patients with complex digestive symptoms may benefit from a gastroenterology consultation.
We assess each patient’s symptoms, medical history, lifestyle and metabolic risk factors, laboratory results and imaging findings as parts of a complete clinical picture. Based on this assessment, we prepare a personalised diagnostic and treatment plan.
What does hepatology involve?
Hepatology is the medical specialty concerned with the diagnosis, assessment, treatment and long-term management of diseases affecting the liver and certain conditions of the bile ducts.
A hepatological assessment may be required not only for patients with a previously diagnosed liver disease. The diagnostic process often begins following the detection of elevated liver enzyme levels, an ultrasound finding suggestive of fatty liver or another previously unexplained abnormality.
The aim is not merely to confirm the presence of an abnormality but to determine its cause and significance, assess the extent of possible liver damage and evaluate the risk of disease progression.
When should you consult a hepatologist?
A hepatology consultation may be recommended for:
- persistently or repeatedly elevated liver enzyme levels,
- elevated AST, ALT, GGT or ALP levels,
- ultrasound findings suggestive of fatty liver,
- suspected metabolic fatty liver disease,
- investigation of liver abnormalities of unknown origin,
- chronic liver disease,
- suspected or confirmed hepatitis B or hepatitis C infection,
- suspected autoimmune liver disease,
- persistently elevated bilirubin levels,
- laboratory abnormalities suggestive of cholestasis,
- an enlarged liver or another liver abnormality identified through imaging,
- follow-up and long-term management of a previously diagnosed liver disease.
Persistent fatigue, discomfort under the right rib cage, itching or jaundice may also be associated with liver or biliary disease. However, these symptoms can occur in many other conditions. A targeted medical assessment is therefore necessary to identify their cause.
Assessment of elevated liver enzyme levels
Elevated liver enzyme levels are a common reason for a hepatology consultation.
An abnormal AST, ALT, GGT or ALP result does not identify its cause on its own, and not all abnormalities indicate the same extent of liver damage.
Possible underlying causes include metabolic fatty liver disease, alcohol-related liver damage, viral infection, liver injury caused by medication or dietary supplements, an autoimmune process or another liver or biliary disease.
The purpose of a hepatological assessment is therefore not merely to repeat an abnormal laboratory test but to investigate the cause of the abnormality in a targeted manner.
Fatty liver and metabolic fatty liver disease
Fatty liver is one of the most frequently detected liver abnormalities. Modern medical terminology refers to fatty liver disease associated with metabolic risk factors as MASLD—metabolic dysfunction-associated steatotic liver disease.
The condition is frequently associated with:
- being overweight or obese,
- insulin resistance,
- type 2 diabetes,
- elevated blood lipid levels,
- high blood pressure,
- other metabolic risk factors.
Fatty liver may remain asymptomatic for a long time. One of the important aims of a hepatological assessment is to determine whether the patient has simple fat accumulation in the liver or whether there are abnormalities indicating inflammation, fibrosis or an increased risk of more advanced liver disease.
Assessment and follow-up therefore involve not only checking liver enzyme levels but also evaluating the patient’s complete metabolic and hepatological risk profile.
Autoimmune liver and biliary diseases
At the SanBer Medical hepatology clinic, we place particular emphasis on the diagnosis and management of autoimmune and immune-mediated diseases of the liver and bile ducts.
This group includes:
- autoimmune hepatitis (AIH),
- primary biliary cholangitis (PBC),
- primary sclerosing cholangitis (PSC),
- certain overlapping autoimmune conditions.
Autoimmune hepatitis
Autoimmune hepatitis is a chronic, immune-mediated inflammatory disease of the liver. Its presentation can vary. Some patients experience fatigue or other general symptoms, while in other cases elevated liver enzyme levels detected during a routine laboratory test lead to the diagnosis.
The condition cannot be diagnosed based on a single laboratory result. The clinical picture, liver enzyme levels, immunoglobulin levels, autoantibody tests and, where necessary, additional diagnostic findings must be evaluated together.
Primary biliary cholangitis
Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease that primarily affects the small bile ducts within the liver.
The condition may initially be asymptomatic and is frequently suspected following the detection of cholestatic abnormalities during laboratory testing. Some patients may experience fatigue or itching.
Primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is a chronic, immune-mediated disease affecting the bile ducts.
In addition to laboratory results, imaging of the bile ducts and assessment of the complete clinical picture play particularly important roles in the diagnostic process.
Autoimmune and immune-mediated liver diseases may require long-term specialist follow-up. This may include regular assessment of disease activity, the condition of the liver, the effectiveness of treatment and possible complications.
Assessment and management of chronic liver diseases
Chronic liver diseases can develop for various reasons and may cause few symptoms for a long time.
Possible underlying causes include:
- metabolic fatty liver disease,
- alcohol-related liver disease,
- chronic viral hepatitis,
- autoimmune liver disease,
- liver damage caused by medication or another substance,
- other liver diseases.
Persistent liver damage may eventually lead to scar tissue formation in the liver, known as fibrosis, and in advanced cases to liver cirrhosis.
In addition to identifying and treating the underlying condition, an important aim of hepatological care is to regularly assess the extent of liver damage, disease progression and the risk of possible complications.
What does a hepatological assessment involve?
The basis of a hepatological assessment is a detailed specialist consultation.
During the consultation, the hepatologist reviews:
- the patient’s current symptoms,
- previous medical conditions and operations,
- previous laboratory results,
- liver enzyme levels and other liver-related laboratory results,
- previous abdominal ultrasound and other imaging examinations,
- medications and dietary supplements taken regularly or occasionally,
- information about alcohol consumption,
- metabolic and other risk factors for liver disease.
Based on the available results, the specialist determines which additional examinations may be required.
Laboratory tests and diagnostic imaging
Accurately assessing liver disease often requires the combined evaluation of laboratory tests and diagnostic imaging.
Depending on the medical issue, laboratory testing may include liver enzyme levels and other liver-related parameters, as well as tests for metabolic, viral and immunological abnormalities.
Diagnostic imaging—particularly an abdominal ultrasound examination—may provide information about the size and structure of the liver, the presence of fatty liver and certain liver or biliary abnormalities.
Where necessary, the specialist may recommend further targeted examinations.
The aim of the assessment is always to identify not only the laboratory or imaging abnormality but also its underlying cause and clinical significance.
Follow-up and management of a known liver disease
Many chronic liver diseases require regular specialist monitoring.
Hepatology follow-up provides an opportunity to:
- monitor the activity and condition of the liver disease,
- assess laboratory results,
- review imaging findings,
- evaluate the effectiveness and tolerability of treatment,
- identify possible disease progression,
- assess the risk of complications,
- prepare a personalised plan for further examinations and follow-up appointments.
The purpose of long-term care is to ensure that the liver disease is not assessed only at a particular point in time but monitored throughout its long-term progression.
What should you bring to your first hepatology consultation?
If available, please bring:
- previous laboratory results,
- reports from abdominal ultrasound and other imaging examinations,
- previous gastroenterology or hepatology documentation,
- hospital discharge summaries,
- immunological test results,
- previous hepatitis test results,
- a list of medications and dietary supplements you take regularly.
Comparing previous results can be particularly valuable because it enables the specialist to assess not only the patient’s current condition but also changes in laboratory and imaging abnormalities over time.
Hepatology clinic at SanBer Medical
Investigating liver disease is often a complex process. An elevated liver enzyme level, an ultrasound finding suggestive of fatty liver or a positive immunological test result does not provide a complete picture of the condition of the liver on its own.
At the SanBer Medical hepatology clinic, we therefore assess the patient as a whole, considering symptoms, medical history, laboratory abnormalities, imaging findings and risk factors together.
Our goal is to accurately identify the cause of the liver disease, assess the extent of possible liver damage and, where necessary, prepare a personalised treatment and long-term care plan.
Comprehensive hepatological assessment, a modern diagnostic approach and personalised specialist care at SanBer Medical.
Book an appointment for a hepatology consultation.