What They Do and Why You’d See One

A hepatologist is a doctor who specializes in diagnosing and treating liver and biliary system conditions, like fatty liver disease, cirrhosis (severe scarring), hepatitis, and liver tumors.

Hepatologists diagnose and treat conditions affecting the liver and biliary system, which is all the organs that make and store bile, a fluid that helps digest fat. These organs include the liver, pancreas, bile ducts (tubes that carry bile), duodenum (first part of the small intestine), and gallbladder.

Hepatologists look at your symptoms and recommend tests to help manage your condition. They’ll also be able to tell when a liver transplant is necessary and provide follow-up treatments.

Hepatologists mainly diagnose conditions that affect the liver, such as:

• Cirrhosis
• Alcohol-related and nonalcoholic fatty liver disease
• Nonalcoholic steatohepatitis (NASH)
• Malignant (cancerous) and benign (noncancerous) liver tumors
• Hepatitis
• Liver cancer
• Wilson disease, a condition that causes copper buildup in the liver, brain, cornea, and other organs
• Hemochromatosis, an inherited condition that causes iron buildup in several organs
• Alpha-1 antitrypsin deficiency, a condition that mainly affects children and causes lung and liver damage

Hepatologists may also help diagnose biliary system conditions, including:

• Primary biliary cholangitis, a chronic (long-term) condition where the bile ducts in the liver become swollen and eventually permanently damaged
• Primary sclerosing cholangitis, a chronic condition that causes swollen, damaged, and scarred bile ducts inside and outside of the liver
• Gallstones (hard deposits that form in the gallbladder)
• Pancreatitis (inflammation of the pancreas)
• Bile duct cysts
• Bile duct cancer

Procedures They Perform

In some cases, hepatologists may perform or oversee certain diagnostic procedures. These procedures may include:

• Liver biopsy: This involves removing a small part of liver tissue to examine and diagnose a liver condition.
• Imaging tests: These tests, such as an ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or X-ray, capture images inside the body and can detect abnormal growths in the liver or blockages in the bile ducts.
• Hepatic venous-portal gradient measurement: This test measures the blood pressure in the portal veins, which helps to see if you have portal hypertension, a condition that causes higher-than-normal blood pressure and is common with liver cirrhosis. Portal veins carry blood from the digestive organs (stomach, intestines, spleen, pancreas, and gallbladder) to the liver.
• Endoscopic ultrasound: This combines an endoscopy and ultrasound to detect problems in the liver and bile ducts. Endoscopies use an endoscope, a tube with a small light and camera attached, to look inside organs.
• Elastography (FibroScan): This test checks if the liver is stiffer than normal, which is a sign of liver fibrosis (early liver scarring).
• Hepatobiliary iminodiacetic acid scan (HIDA): This imaging scan uses a radiotracer—an injected, swallowed, or inhaled substance—to check for any abnormalities in the biliary system.

Hepatologists can be broadly categorized into three types:

• Clinical hepatologists: They manage a wide range of liver and biliary system conditions inside and outside of traditional office visits.
• Transplant hepatologists: They specialize in evaluating, preparing, and managing people who need liver transplants.
• Pediatric hepatologists: They specialize in diagnosing and treating liver conditions in infants, children, and adolescents.

Your healthcare provider may refer you to a hepatologist if you experience the following symptoms:

• Jaundice (yellowing of the eyes and skin)
• Swelling of the abdomen and legs
• Easy bruising
• Changes in the color of stool or urine
• Unintentional weight loss
• Loss of appetite
• Fever and chills

Your healthcare provider may refer you to a hepatologist for your symptoms. They can recommend diagnostic tests to determine your liver condition and recommend suitable treatment options.

How To Prepare

Before visiting a hepatologist, you may want to gather all your medical records from previous healthcare providers, including:

• Any family or medical history related to liver conditions
• All past and present symptoms
• Imaging scans and test results
• A list of all current medications or supplements you’re taking, and how long you’ve been taking them for

Consider preparing a few questions or concerns you want to discuss with your hepatologist. Also, be sure to check your insurance before your visit to see if it will cover the appointment or if you’ll need to pay out of pocket.

What To Expect

When seeing a hepatologist, they’ll likely do the following:

• Ask you about your symptoms, medical history, and your diet and lifestyle choices that may make you more likely to develop a particular liver condition
• Perform a physical exam to look for signs of liver conditions, such as jaundice or abdominal pain and swelling
• Recommend a few tests, such as liver function tests, imaging tests, or liver biopsy, to see if your liver is functioning properly

If you do have any liver conditions, your hepatologist will likely want to schedule regular follow-ups to monitor your progress and adjust treatment as necessary.

Hepatologists are doctors who diagnose and treat liver and bile duct conditions. Your healthcare provider may refer you to a hepatologist if you have symptoms of a liver condition.

Your hepatologist will likely suggest diagnostic tests to determine your condition and treatment based on your results. They’ll also schedule follow-up visits to check if your treatment is working or if you need new treatment options.