Gastroenterology & Hepatology

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Division of Gastroenterology & Hepatology

Liver Disease

At the Medical College of Wisconsin, our hepatologists treat a wide variety of liver diseases. Our hepatology team manages the following diseases, and more:

Viral Hepatitis
Fatty Liver Disease
Alcoholic Liver Disease
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Autoimmune Liver Disease
Hemochromatosis
Wilson Disease
Drug-Induced Liver Disease
Liver Cancer Basics
Liver Transplant
Liver Biopsy

Fatty Liver Disease

Fatty liver disease, also known NAFL-D (non-alcoholic fatty liver disease) is now the most common liver disorder in the United States.  The disorder is associated with excess body weight, diabetes and high cholesterol and may be present in more than 20% of the US population. The severe form of fatty liver known as NASH (non-alcoholic steatohepatitis) can, in some cases progress to cirrhosis and liver cancer, requiring liver transplantation Treatment is focused on correcting the underlying risk factors such as weight control and diabetic control.  Extensive research is ongoing regarding new therapies for fatty liver disease. Our team’s active research is focused on understanding the genetic risk factors for fatty liver and improving its diagnosis.

At Medical College of Wisconsin, we are able to provide a multidisciplinary approach offers a better opportunity for successful weight loss. The treatment team includes hepatologists (physicians specializing in liver disease), endocrinologists, bariatric surgeons, dieticians and nutritionists who provide personalized dietary counseling for weight loss and maintenance.

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Alcoholic Liver Disease

Alcohol related liver disease continues to be one of the leading causes of liver damage.  Alcohol is a toxin which directly damages liver cells.  In order to treat alcohol-related liver disease--including alcoholic hepatitis, alcoholic fatty liver disease, and alcoholic cirrhosis of the liver-- maintaining abstinence from alcohol is crucial.

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Primary Biliary Cirrhosis (PBC)

Primary Biliary Cirrhosis (PBC) is a disorder that affects the small bile ducts within the liver.  Patients tend to present with complaints of itching because of the inability of the bile to drain through the damaged bile ducts.  The disease also has other systemic complications including bone disease, increased risk of fluid retention and gastrointestinal bleeding.  The cause of primary biliary cirrhosis appears to be a disorder of the immune system whereby the bile ducts are attacked aggressively by antibodies, the most common of which is the antimitochondrial antibody.  A medication called ursodeoxycholic acid is effective therapy at slowing down the progression of this disease.  Unfortunately, many patients progress to end-stage liver disease and need liver transplantation.  For this reason, monitoring this disease at a liver transplant center is beneficial.

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Primary Sclerosing Cholangitis (PSC)

Primary sclerosing cholangitis (PSC) is a condition similar to primary biliary cirrhosis, however, the large and medium-sized bile ducts are usually involved in this condition.  PSC is often associated with concomitant inflammatory bowel disease (ulcerative colitis, Crohn's disease).  Comprehensive treatment is offered at the Medical College of Wisconsin in conjunction with our Gastroenterology and Interventional Radiology colleagues. There is no effective medical therapy for primary sclerosing cholangitis and many of the patients progress to cirrhosis and are at increased risk for bile duct cancer (cholangiocarcinoma).  Liver transplantation offers the only effective long-term therapy in patients with advanced disease, therefore monitoring the disease course at a liver transplant center is essential.

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Autoimmune Liver Disease

Autoimmune hepatitis occurs when a person’s own immune system (antibodies) attacks the liver cells. The diagnosis is supported by typical blood tests, antinuclear antibodies and anti-smooth muscle antibodies in the blood.  A liver biopsy may be performed to aid in the diagnosis and stage the disease.  Symptoms may include fatigue, jaundice and malaise.  Our team of hepatologists uses various oral medications that modulate the immune system and are effective for managing autoimmune liver disease. When this condition is diagnosed at an early stage, medical therapy is quite effective; however, patients with advance disease may require liver transplantation.

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Hereditary Hemochromatosis

Heredity hemochromatosis is a disease in which iron accumulates in various organs in the body, including the liver, due to a genetic defect.  When this occurs the liver can become cirrhotic and is also at an increased risk for liver cancer.  Heredity hemochromatosis is found in about 1 out of every 250 Caucasian patients in the United States and more frequently in those of Northern European descent.  Diagnosis can easily be confirmed by a blood test to evaluate the amount of iron in the body as well as a genetic test, which detects whether the gene responsible for this condition is present. Liver biopsy may be performed to stage the disease. Therapy aims at removing the excess iron from the blood and is typically done by phlebotomy or blood removal.  More advanced cases may require liver transplantation.

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Wilson Disease

Wilson disease is a disorder that occurs from a defective gene that causes copper accumulation in the body including the liver and various parts of the brain.  Patients frequently present with a variety of neurologic symptoms and/or with evidence of liver failure.  While not as common as hereditary hemochromatosis, Wilson disease when diagnosed early can be effectively treated.  More advanced cases of Wilson disease may require liver transplantation.

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Drug-Induced Liver Injury

A wide variety of medications and herbal supplements can damage the liver.  Some may damage the liver rapidly and others over a period of time.  Withdrawing the medication may reverse this problem; however, some patients may require liver transplantation due to severe drug-induced liver disease.

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Cirrhosis

Cirrhosis is irreversible scarring of the liver.  There are many causes and severities of cirrhosis but the most common causes in the US are hepatitis C, alcohol, and fatty liver disease.  Cirrhosis can be diagnosed on a liver biopsy and occasionally on an ultrasound or CT scan of the abdomen.  Laboratory testing usually suggests advanced liver disease including cirrhosis. 
The complications of cirrhosis include bleeding from the gastrointestinal tract as accessory blood vessels known as varices form.  Fluid accumulation in the abdomen, known as ascites, is also common and there is a possibility that this fluid may become infected presenting as a condition known as spontaneous bacterial peritonitis.  Because the liver filters waste products from the bloodstream, a condition known as hepatic encephalopathy can develop if the liver is injured to a degree where it cannot remove these waste products from the body.  The complication of this is a mental slowing or confusion, which is reversible and can be treated successfully with medications if properly diagnosed. At the Medical College of Wisconsin, our hepatology team has expertise in managing these complications and helping patients achieve a better quality of life.  Cirrhosis may require liver transplantation; therefore, treatment at a transplant center is essential.

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Liver Cancer Basics

The Medical College of Wisconsin offers a multidisciplinary highly experienced treatment team including hepatologists, oncologists, surgeons, interventional radiologists, transplant specialists and other specialists to offer the most comprehensive treatment of different types of liver cancer. Learn more about our approach to treating liver cancer.

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Liver Transplant

The Medical College of Wisconsin hepatologists, transplant surgeons, nursing specialists and other members of the transplant team work together to provide comprehensive, ongoing care for individuals who need a liver transplant. Our transplant program outcomes are among the best in the nation. Learn more about our approach to liver transplantation.

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Liver Biopsy

The liver biopsy is a safe procedure when standard precautions are taken.  The risk of bleeding that may require transfusion is less than 2% and the risk to adjacent organs is also in the range of 2%.  Because of this risk, blood thinners such as aspirin or NSAIDs should be held prior to the procedure.  The procedure is typically done by localizing an area in the right upper quadrant immediately on top of the liver.  The area is cleaned with a sterile solution and a local anesthetic is applied.  Once the area has been anesthetized a slightly larger needle is passed through this area rapidly into the liver and then withdrawn.  The sample is available immediately and is sent to pathology for microscopic examination.  The patient is typically monitored for several hours in the hospital but is discharged to home, if there are no complications and normal activity can be resumed by the next day.  No sutures are necessary and no scar forms.

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Page Updated 03/31/2014