Hepatology - Overview

If you are reading these pages there is a chance you or someone close to you have been told that you or they have abnormal liver tests. Presently in developed countries, the most common cause of abnormal liver tests is fat induced liver cell damage - Non Alcoholic Fatty Liver Disease (NAFLD). The more progressive stage of NAFLD is called non alcoholic steatohepatitis (NASH). NAFLD and NASH are now more common than hepatitis B, C or other causes of liver disease.

NAFLD is primarily caused by insulin resistance which for a variety of reasons causes fat deposition in the liver. The fat itself damages the liver cells and the resulting inflammation, leads to activation of scar forming liver cells. The scar forming process is called fibrosis. Over-exuberant deposition of scar tissue is known as cirrhosis. Cirrhosis is a stage of liver disease where the normal and neat architecture of the liver is destroyed and liver function may be disturbed. Not all patients with fat induced liver disease will develop cirrhosis: only a proportion will after many years. However it is important to appreciate that NAFLD is not a benign disease. It may progress.

The course of the disease is determined by whether there is fat alone (steatosis) or fat plus inflammation in the liver (NASH). The separation of NAFLD into those with and inflammation i.e. steatosis or steatohepatitis can only really be made after a liver biopsy. There are emerging scoring systems that my help the decision about whether a liver biopsy is needed.

Other causes of abnormal liver tests include alcohol, viruses – Hepatitis A, B and C, immune based liver disease (auto-immune liver disease, primary biliary cirrhosis and primary sclerosing cholangitis), metabolic liver diseases (haemochromatosis and Wilson’s disease), Coeliac disease, alpha-1 anti-trypsin deficiency and medicines.

To know which of these many conditions from NAFLD to viral hepatitis is causing the abnormal liver tests requires an initial battery of specialised tests and an ultrasound scan of the liver. A liver biopsy may be required to help make the diagnosis. The decision however, as to whether to perform a liver biopsy will be taken after detailed discussion with you in light of blood tests and scan results.

The London Hepatology Practice offers a comprehensive hepatology service and we are able to manage patients with the complete spectrum of liver diseases from alcoholic liver disease, viral hepatitis, immune and metabolic based liver disease, to NAFLD. The principal Hepatologist is Dr Jude A. Oben. Dr Oben BM, BCh, PhD, MRCP is an Oxford and Johns Hopkins University trained Hepatologist. The primary research of Dr Oben’s group is NAFLD and viral hepatitis induced liver injury and the factors that govern liver fibrosis and liver stem cells and liver regeneration. He holds an NHS Consultant appointment at Guy’s and St Thomas’ hospital.


Click here for more information on specialist hepatology consultants at London Bridge Hospital

  • Useful links:
  • www.aasld.org - American Association for the Study of Liver Diseases
  • www.easl.ch - European Association for the Study of the Liver

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