Professor Kevin Peter Moore

Professor Kevin Peter Moore
Hepatology
Central London


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Professor Kevin Peter Moore

Hepatology in
London

MB BS FRCP BSc PhD

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Professor Kevin Peter Moore areas of expertise:

Professional statement

Professor Kevin Moore is one of London's leading and most reputable liver specialists. He is Professor of Hepatology at University College London (UCL) and sees and treats all forms of liver disease at the Royal Free London Foundation Trust.  For twenty years, he was an integral part of the liver transplant team which lead the treatment of cirrhosis complications.

Professor Moore sees patients with a wide variety of liver problems from abnormal liver function tests to advanced cirrhosis.  He currently leads the Alcohol Care Team at the Royal Free London NHS Foundation Trust and treats patients with alcohol dependency and alcohol-related liver problems, as well as fatty liver disease, autoimmune liver disease and cirrhosis.

Professor Moore chaired the writing of the National Plan for Liver Services in 2010, has published two books in acute medicine (Oxford Handbook of Acute Medicine and the Oxford Desk Reference), and has been widely published in numerous peer-reviewed journals. 

 Videos of doctor

What is a Fibroscan of the liver?

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 Doctor's articles

Dry january
The effect of Dry January: What happens...

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 Credentials

GMC: ‍2845652

 Professional experience

• More than 35 years of experience
• Clinical Hepatologist, Royal Free London Foundation Trust (present)
• Leader of the Alcohol Care Team, Royal Free London Foundation NHS Trust (present)
• Senior Registrar, Hammersmith Hospital (1990 - 1994)

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 Sub-specialties

• Abnormal liver function tests
• Fatty liver
• Alcohol related liver disease
• Autoimmune liver disease
• Drug induced liver disease
• Liver transplantation advice

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 Positions in public associations

• Secretary, British Association for Study of the Liver (1995 - 1997)
• Secretary, International Ascites Club (1997 - 1999)
• Medical Advisory Committee of British Liver Trust (1997 - 2001)
• Non-Executive Director, North Middlesex University Hospital NHS Trust (2008 - 2012)
• Liver Section Committee of the British Society of Gastroenterology (2008 - 2011)
• Chair: Non-alcoholic fatty liver disease group for the National Strategy for Liver Disease (2010 -2012)

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 Teaching posts

• Lead for Digestive Health MBBS, UCL
• Course Director Applied Medical Sciences, UCL
• Senior Lecturer in Medicine, Centre for Hepatology (1999 - 2003)

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 Education

• Doctor of Philosophy (Biochemistry), King's College, London
• Bachelor of Medicine/Bachelor of Surgery (Clinical Medicine), King's College, London
• Bachelor of Science (First Class Honours) – Biochemistry in King's College London
• Certificate of Completion of Specialist Training (CCST) in Gastroenterology, Clinical Pharmacology and Therapeutics as well as General Internal Medicine

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 Publications and conferences

• Associate Editor, GUT (medical journal)
• Associate Editor, American Journal of Pathology
• Associate Editor, Free Radical Biology and Medicine
• Has written over 75 original publications, 25 review articles, and 3 book editions of The Oxford Handbook of Acute Medicine

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 Prizes and awards

• MRC Training Fellowhip (1987 - 1990)
• MRC Senior Clinical Fellow (1994 - 1999)

 Professional membership

• Fellow of the Royal College of Physicians
• British Association for Study of the Liver
• British Society of Gastroenterology
• European Association for Study of the Liver
• Association of Physicians (Current Treasurer, Secretary 2011 - 2013)
• American Association for the Study of Liver Disease (AASLD)

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Languages spoken

  • English

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Diseases, Medical Tests and Treatments

Alcoholic liver disease

This disease, also known as ARLD, is caused by excess alcohol consumption. The liver usually regenerates, but with excess alcohol consumption over tim ...

Alcoholism

What is alcoholism? Addictions to toxic substances are chronic diseases that affect the brain and behavior, characterised by the dependence on one ...

Ascites

This condition is an accumulation of fluid in the peritoneal cavity, located in the abdomen area, as the fluid accumulates it distends the abdomen. It ...

Cirrhosis

What is cirrhosis? Cirrhosis is a disease in which the liver gradually deteriorates due to chronic injury and scarring which results from a variety ...

Fatty liver

What is fatty liver? Fatty liver disease is the accumulation of fatty acids and triglycerides in liver cells. There are two types: Non-alcoholic fatty liver disease: it is the most common cause for obesity due to a build-up of fat in the liver cells. There are other factors that can also trigger the disease, such as oxidative stress, the production and release of toxic inflammatory proteins, or necrosis or death of liver cells. Alcohol-related liver disease, also known as alcohol hepatic steatosis: as the name suggests, this disease is caused by excess alcohol intake. The liver breaks down most of the alcohol but during the process, harmful substances to the liver are released that cause inflammation and weaken the body’s natural defences.     What are the symptoms?  Symptoms of this disease include upper right abdominal pain, general malaise, and chronic fatigue, among others. However, many patients don’t have symptoms but are diagnosed after having certain imaging tests such as an ultrasound or CT scan for other reasons.   These imaging tests are not always able to diagnose this disease, for this it’s best to undergo laboratory testing to be able to assess the degree of liver injury by assessing liver enzymes or transaminases.       Causes of fatty liver?   Specialists are still unsure as to why some people accumulate fat in the liver and others don’t.  An important factor is that some cases of fatty liver develop swelling which could turn into cirrhosis. There are however some common factors for both types of fatty liver: being overweight or obese, insulin resistance, when cells don’t process sugar in response to the hormone insulin, and high blood sugar levels (hyperglycaemia) which can indicate prediabetes or type 2 diabetes and / or high levels of blood fats, particularly triglycerides.   How can it be prevented? In most cases, fatty liver can be prevented if certain lifestyle changes are made, such as following healthy guidelines based on a varied, balanced, and low fat diet. Since alcohol is one of the things that damages the liver, it is very important to stop consuming alcohol.     Another important factor is to exercise regularly as that helps burn fat; exercises can be aerobic, such as running or walking.         What is the treatment?            There is no specific treatment for this disease, however it has been shown that weight loss, regular exercise, and following a balanced diet can help reduce fat in the liver. Controlling cholesterol levels, diabetes, and / or any other cause for a build-up of fat in the liver is also important. In cases of morbid obesity, bariatric surgery may be recommended.         ...

Haemochromatosis

What is haemochromatosis? Haemochromatosis is an inherited condition in which the blood has too much iron in it. Although iron is an important component of the blood, iron overload can damage the liver, pancreas, heart, and joints, among other body parts, leading to unpleasant symptoms. Haemochromatosis most commonly affects white Europeans, particularly people of Celtic origin.   What are the symptoms of haemochromatosis? Haemochromatosis causes iron to build up in the blood over many years. Symptoms usually start to manifest between the ages of 30 and 60. Common symptoms include: Constant fatigue Weakness Weight loss Joint pain Irregular or absent periods in women Erectile dysfunction in men As the condition progresses, more serious symptoms can follow as effects of complications such as liver dysfunction: Darkening of the skin Jaundice Abdominal pain and/or swelling Severe joint pain Loss of libido Constant thirst and frequent urination Chest pain Shortness of breath Swelling in the extremities Arrhythmia Shrinking testicles in men   Causes of haemochromatosis Haemochromatosis is caused by a faulty gene which affects the way the body absorbs iron during digestion of food. Normally, the body absorbs only what it needs, regulating the iron levels in the blood, but in haemochromatosis, the body can’t control this absorption, leading to rising iron levels over time. The gene responsible (known as HFE) is recessive, meaning that both parents must pass the gene on for the child to be at risk of inheriting the haemochromatosis, and even then, the chances of the condition manifesting are low. It is not fully understood why.   What is the treatment for haemochromatosis? Haemochromatosis cannot be cured, but the symptoms can be treated; that is, the amount of iron in the blood can be reduced to lower the risk of damage to the joints and organs. Treatments include: Phlebotomy – also known as venesection, and is similar to giving blood. A needle is used to drain a small amount of blood. Red blood cells (RBCs) contain iron, so your body will use some of its excess iron to replace the removed RBCs. Patients will receive regular phlebotomies until their iron level normalises, and then less frequently afterwards to maintain a normal level. Chelation therapy – if the patient cannot undergo phlebotomy due to fragile blood vessels, for example, medication may be used to release excess iron in the urine or faeces. Chelation therapy is not frequently recommended. Dietary changes are not generally recommended if the patient is having one of the above treatments. However, you may be advised to avoid any sources of “extra” iron, such as supplements and “fortified” breakfast cereals. ...

Autoimmune hepatitis

Autoimmune hepatitis happens when the body's immune system recognises the liver cells as foreign and starts to attack them, damaging this vital organ. ...

Drug induced liver injury

This condition is caused by ingestion of medication, supplements or herbal remedies that are toxic and damage liver function. The effects can be jaundice, liver failure or even death, and usually occur after long-term exposure to the toxin. ...

Endoscopy

What is it? Endoscopy is the use of cameras to relay images from inside the body.  The device used, known as an endoscope, is a long thin flexible tube with a camera at one end and a light source. What does it involve? Endoscopes are inserted in to the body via a natural opening such as the mouth or the anus. There are different types of endoscopy depending on the site and function of the procedure – if the bowel is to be investigated for example, it is referred to as a colonoscopy. If the airways are to be examined, the procedure is referred to as a bronchoscopy. Endoscopy can also be used for surgery, as in the case of laparoscopic surgery – in this situation the laparoscope (a specific type of endoscope) is inserted through small incisions. Once inserted, the endoscope is able to send images from the inside of the subject’s body back to a TV screen. What is it for? Endoscopy is most commonly used to investigate symptoms and help to diagnose conditions relating to the digestive system, although it can be deployed to produce images and aid with many other parts of the body, including the respiratory system, the urinary tract and the female reproductive system. An endoscope can also be used to assist with surgery. An endoscopy is commonly used to investigate symptoms such as abdominal pain, nausea and vomiting, unexplained weight loss, diarrhoea, blood in the stool or vomiting blood. How can you prepare for it? You may be required to avoid food and liquids for a period beforehand, depending on what type of endoscopy you are undergoing. In the case of a colonoscopy, you might be given laxatives to help you evacuate any stool beforehand. You may also be required to stop taking certain medication such as blood thinners to prevent excess bleeding from the procedure. What does it feel like during the procedure? The procedure usually only causes mild discomfort although a local anaesthetic is also sometimes used. It is normally performed with the patient conscious, although sedatives can be deployed to help you relax. Antibiotics are sometimes used to reduce risk of infection. What would a “bad” result mean? An endoscopy can be used to diagnose a wide range of conditions and the results are interpreted by a specialist.  Whether the results are good or bad clearly depends on what symptoms are being investigated and on which part of the body the endoscopy is being performed. ...

FibroScan

What is it? A Fibroscan is a test that allows the assessment of hepatic fibrosis as well as the quantification of liver fat. It is a non-invasive technique that is fast and reliable. It is particularly useful as an alternative to a biopsy.       Advantages of the Fibroscan      Regardless of the cause, diseases affecting the liver generally cause inflammation which destroys cells. After this, repair techniques naturally develop with a progressive accumulation of collagen fibre.   Knowing the degree of fibrosis is useful for diagnosing as well as monitoring and checking any disease progression. In the past this was traditionally done by a liver biopsy. A biopsy involves removing a small sample of the liver to analyse it by puncturing the skin or via the intrahepatic (transjugular) veins. Despite having been the most widely used technique, a liver biopsy has its drawbacks. The patient must be at the hospital for between 12 and 24 hours, and the assessment is not always easy to read as liver fibrosis distribution is vague and not homogenous. Complications may arise from a liver biopsy, however, most are mild such as pain at the puncture site, around the liver area, or in the neck or shoulder. More serious complications may include haemorrhage, pneumothorax (collapsed lung), haemothorax, organ perferation, biliary peritonitis, and in very extreme but rare cases, death.      How can you prepare for it? The patient should fast for two hours before the test. Once there, they lie down with their right arm raised and placed behind the neck. A transducer or probe is used to measure, and a gel is used on the surface. As it is a non-invasive test, the patient will not feel any discomfort. There are larger scanners available for obese patients. At least 10 measurements are made.   Why would you do it?  Fibroscan is quite commonly used in patients who have been diagnosed with or are being monitored for hepatitis C (HCV), chronic hepatitis due to hepatitis B (HBV), a combination of hepatitis C and HIV, alcoholic liver disease, hepatic steatosis (fatty liver) non-alcoholic, chronic cholestatic diseases, liver cirrhosis, and monitoring for pre- and post-liver transplant patients.    What would a “bad” result mean? Cases of non-alcoholic fatty liver disease and fatty liver are on the rise in the UK. An increase in the number of new cases is expected due to population diet changes and the increase in metabolic syndromes linked to obesity, high blood pressure, diabetes, and dyslipidaemia (increase in cholesterol and triglycerides). As well as measuring fibrosis and the CAP (Controlled Attenuation Parameter), the fibroscan is able to quantify liver fat content, which is crucial for early diagnosis. The test allows the physician to find out the stage of the liver fibrosis (hardness), from a mild stage to a more advanced stage (cirrhosis). Who performs a Fibroscan? Fibroscan tests are largely performed by hepatologists and gastroenterologists. ...

Haemangioma

What is a haemangioma? A haemangioma is a type of birthmark that is formed by a collection of blood vessels just under the skin. It is often referred to as a “strawberry mark” because of its reddish colour and texture. Haemangiomas can be superficial or deep. A superficial haemangioma is simply a raised red area on the surface of the skin, whereas a deep haemangioma involves swollen blood vessels deeper in the skin which can make give it a bluish hue. Haemangiomas can vary in size, and can develop anywhere on the body. They are very common, affecting about 5% of babies soon after birth. Can haemangiomas disappear on their own? Haemangiomas tend to increase in size rapidly for the first six months, but most will begin to shrink in size afterwards. They tend to disappear at the age of seven. Because of this, treatment is not normally recommended for haemangiomas, but might be considered if the haemangioma is: developing extremely rapidly growing near the eye and beginning to interfere with vision growing near the nose and causing breathing difficulties growing near the mouth and making it difficult to eat causing the surrounding skin to become deformed or stretched forming an ulcer In these situations it would be advisable to seek advice from a dermatologist. What causes haemangiomas? It’s not clear what causes haemangiomas, but they might be the result of placental tissue early in pregnancy. There doesn’t appear to be any genetic link – having another relative with a haemangioma doesn’t increase the chances of a child developing one. How is a haemangioma treated? If the haemangioma has ulcerated, the doctor will likely recommend pain relief medication and offer advice on washing and dressing the area to keep it from being infected. If it has become infected, antibiotics might be necessary. If the haemangioma is near the eye, lips or nappy area, it can usually be treated with a medicine called propranolol, which should cause the birthmark to shrink. Sometimes steriods or vincristine are used as alternatives when propranolol doesn’t work. Laser treatment is usually recommended when the birthmark has stopped shrinking, or if it’s situated in the airway and causing breathing difficulties. It can also be an effective treatment for reducing the redness of the birthmark. Finally, plastic surgery can be useful if the skin around the birthmark is stretched or deformed and you’d like to improve its appearance. Which type of specialist treats haemangioma? There are a range of specialists who have the potential to be involved in haemangioma treatment, depending on where the birthmark is. Laser treatment can be carried out by a dermatologist, where as surgery to improve the skin is carried out by a plastic surgeon. If laser treatment involves working in the airways, treatment might involve a pulmonologist or thoracic surgeon. Finally, if the haemangioma is affecting the eye then it might require the attention of an ophthalmologist. ...

Hepatic encephalopathy

This disease describes the changes in the brain that happen after liver disease. A healthy liver filters toxins from the blood, but when it is damaged harmful toxins and chemicals can get to the brain causing an array of symptoms like confusion, sleepiness, anxiety, fatigue and in extreme cases seizure. ...

Hepatology

What is hepatology? The word ‘hepatology’ comes from the Ancient Greek ‘hepar’ or ‘hepato’, meaning ‘liver’; and ‘ology’, referring to the study of a particular. Hepatology as a medical specialty concerns the study of the liver, gallbladder, pancreas, and biliary ducts, and the management of related disorders. Hepatologists may also be referred to as ‘liver specialists’. What subspecialties are included under hepatology? Over the years, hepatology has evolved from being considered as a subspecialty of gastroenterology, to a specialty within its own right. Gastroenterology focuses on the entire digestive system and related disorders, including study of the colon, anus, intestine, stomach, and liver, among other organs and functions, while hepatology focuses primarily on the liver. Hepatology is a rapidly expanding field, thanks to further understanding of the ‘subspecialty’ itself, and medical advances in the treatment and study of the liver. As it has only recently gained understanding as its own separate specialty, there are few official offshoots from it as a whole, though paediatric hepatology is a notable area of study. What conditions does a hepatologist treat? Liver specialists treat conditions affecting the liver, in addition to the diagnosis and treatment of conditions affecting the biliary systems (e.g the pancreas, biliary ducts, and gallbladder). Some conditions a hepatologist would treat include: Alcohol damage to the liver Cirrhosis Liver disease Fatty liver disease Hepatitis Liver cancer Gallstones Pancreatitis Hepatologists will also often monitor patients undergoing liver surgery, both pre-operation and post-operation. They may also refer patients for liver surgery if they deem it necessary. When should I see a hepatologist? You may be referred to see a hepatologist if you have an ongoing liver problem, such as alcohol damage, cirrhosis, fatty liver disease, or hepatitis. You also may be referred to a hepatologist if your GP decides you need a FibroScan, which is a special test used as an alternative to a liver biopsy. This is a test which can measure the level of hepatic fibrosis and the quantity of liver fat. FibroScan is non-invasive, meaning the amount of damage to the liver is assessed without any samples being removed. ...

Jaundice

What is jaundice? Jaundice is a disorder that causes the skin and white parts of the eyes to turn a yellowish colour. It is not a disease in itself, but rather a symptom of something happening. Jaundice occurs when there is an excess of bilirubin, a yellow compound which is formed by red blood cells breaking down in the body. What are the symptoms? The main symptom of jaundice is yellow discoloration of the skin and mucous membranes. In some cases, other symptoms such as coluria (very dark urine) and acolia (very light stools due to the absence of pigments derived from bilirubin) may occur. Causes of jaundice Jaundice occurs when there is an excess of bilirubin. Bilirubin is a waste product of haemoglobin, which is the main content of red blood cells. This bilirubin is processed in the liver and transported through the bile duct into the small intestine, and eliminated in the faeces. Jaundice occurs when there is an increase in the rate of destruction of red blood cells, for example in certain liver diseases and in diseases where there is a blockage of the bile duct. Can it be prevented? There are some measures which can be taken to prevent jaundice such as: Avoiding excessive consumption of alcohol Receiving the hepatitis vaccine Avoiding certain medications (consult your doctor) What is the treatment? In adults and young children, jaundice should be considered only as a symptom of a disease. Therefore, the treatment should not be for jaundice, but for the disease causing it. In newborns jaundice can occur, but it usually goes away on its own. If the jaundice is mild, then parents should ensure the baby is feeding properly and is kept hydrated. If the jaundice is severe, then certain treatments may be indicated. Blood transfusion can be performed to clear the bilirubin from the blood, or light therapy (phototherapy) may be used in order to promote excretion of bilirubin. ...

Liver

What is the liver? The liver is one of the vital organs, which sits on the right side of the abdomen. The liver is the largest internal organ in the body. It is also a gland, which means it synthesises substances to then release them in the bloodstream. Glands have different functions in the body, and the liver has many, performing over an estimated 500 different functions. What does the liver do? The liver’s main function is to filter the blood which comes through to it from the digestive tract, then pass it around the rest of the body, filtering toxins and making chemicals safe or metabolising them. The liver plays an important part in nutrition, metabolism, hormone production, and functions of the blood. It is an essential organ in the body, and if a significant amount of liver tissue is damaged, it can cause problems such as liver disease. What happens when the liver is not functioning properly? If the liver does not function as it should, different symptoms can appear, such as jaundice (when the skin looks yellow in colour), pain in the abdomen where the liver is located, bruising easily, swelling in the abdomen, nausea or vomiting, sleepiness or perhaps slurred speech, and general fatigue or feeling unwell. Depending on the condition, different symptoms present, and a liver function test may be necessary to determine the cause. Conditions which can affect the liver include: Hepatitis, both viral and non-viral. Scarring on the liver, otherwise known as cirrhosis. Liver failure, where the liver fails to function as it should. There are different stages of liver failure, known as chronic and acute. Chronic liver failure occurs over months or years, whereas acute liver failure comes on suddenly and rapidly. Liver cancer Fatty liver disease There are many more conditions which affect the liver, which can be diagnosed by a GP or healthcare provider, and if necessary treated by a specialist, such as a gastroenterologist, or a hepatologist, a doctor specialising in the liver and its related functions.  ...

Liver biopsy

What is a liver biopsy? A liver biopsy is a procedure that is performed to remove a portion of the liver, which will be examined under a microscope to check for signs of damage or disease. There are three main types of biopsy: laparoscopic, percutaneous, and transvenous. Percutaneous liver biopsy: this is the most commonly-used technique for obtaining a liver sample. It involves making an incision in the abdomen to insert a needle into the liver to take a sample. Ultrasound, CT scans, and other imaging techniques are often used to locate the liver. Some specialists do not use imaging techniques but locate the liver by palpating the abdomen. Once the biopsy is complete, you will have to lie on your left side for up to two hours to reduce the risk of bleeding.    Transvenous liver biopsy: this technique is used if your blood coagulates slowly or if there is excess fluid in the abdomen, a condition known as ascites. With a transvenous biopsy, you lie face up on an x-ray table. A small incision is made in your neck and a tube is inserted into the jugular vein. A contrast dye is then injected to be able to view the veins. This fluid illuminates when x-rays are used. A needle is then inserted through the tube and samples of liver tissue are removed. You will be monitored for at least four to five hours to avoid the risk of bleeding.    Laparoscopic liver biopsy: this type of biopsy is used to obtain a tissue sample from one or more specific areas of the liver, or if there is a risk of infection or cancer spreading. During the test, you will lie on your back and be given a sedative. With laparoscopy, an incision is made in the abdomen, under the rib cage. A tube called a cannula is then inserted and inflated with a gas to give the doctor more space for working in the abdominal cavity. The biopsy needle is inserted through the cannula. Any bleeding can be easily detected with the camera and is stemmed using electric probes. You will be monitored for several hours after the procedure. The liver is a vital organ that has several basic functions, such as: Removing harmful products from the blood Fighting infection Helping in the digestive process Storing energy Storing nutrients. Why is a liver biopsy performed? A liver biopsy is performed when it is difficult to diagnose a possible liver problem with blood tests or by using ultrasound or x-rays. A biopsy is often performed to assess the degree of liver damage, a process known as staging. Staging helps guide treatment, and the biopsy helps to diagnose or detect: Liver cancer Infection Cause of abnormal liver enzyme levels detected in the blood Cause of unexplained thickening of the liver. Preparing for liver biopsy The specialist should be fully informed about any medication you are taking, and you may even be asked to stop taking any medication that affects blood clotting or interacts with sedatives. Some medications that may not be permitted both before or after a liver biopsy are nonsteroidal anti-inflammatory drugs, anticoagulants, antidepressants, antibiotics, dietary supplements and high blood pressure, diabetes and asthma medications. You must not eat or drink for at least eight hours before the biopsy, and should plan how you will get home, since you must not drive for at least twelve hours after the procedure. Before the procedure, you will need to have a full blood test to check, among other things, your ability to clot blood. What do you feel during a liver biopsy? The moment the needle is inserted to sedate you, you will feel a brief, sharp pain. You might feel a deep pain when the biopsy needle is inserted, which sometimes manifests itself in the shoulder. Sedation helps you to remain calm during the process. Sedation is different to anaesthesia; you are unconscious under anaesthetic, but with sedation you can communicate with the medical team, though you generally won’t remember the procedure afterwards. Meaning of abnormal results There are two outcomes from a liver biopsy: either the results are completely normal, which means that the liver tissue is normal, or the liver biopsy reveals the presence of a liver disease, such as hepatitis or cirrhosis, or the presence of cancer cells or infections such as tuberculosis. Some of the problems that can be detected through a liver biopsy are: Hepatitis Haemochromatosis Hepatocellular carcinoma Hodgkin's lymphoma Primary biliary cholangitis Cirrhosis Fatty liver Liver cancer. Advances in liver biopsy The use and advancement of technology has led to a series of changes in general medicine and in the liver biopsy procedure. Major progress has been made in imaging techniques, which are sometimes sufficient to determine the state of the liver. Another advancement is FibroScan, which measures the speed at which elastic waves are propagated through the liver; this helps to assess the health of the liver. ...

Liver cyst

A hepatic cyst is a cyst on the liver. It may be benign or malignant. Often there are no symptoms, but they can be discovered when a scan is performed on the liver. There are different types of hepatic cysts. ...

Liver disease

What are liver diseases?           The liver is one of the biggest and most important organs. It plays a central role in metabolic processes such as keeping the body clean and breaking down nutrients, turning them into energy, while clearing toxins.  Hepatic diseases are those which affect the liver and don’t allow it to do its job.         There are different things that can affect the liver, such as viruses, genetic alterations, excess fat, or excessive alcohol consumption, as well as hepatocellular carcinoma, the primary liver cancer. The most common liver diseases are hepatitis A, B, or C, cirrhosis, hepatocellular carcinoma, jaundice, fatty liver, and haemochromatosis.                 Disease prognosis The main thing to note about liver diseases is that the liver is quite a resilient organ which can recover from smaller ailments and even function with only part of it being healthy. It is a serious issue as until there is liver failure it is often not known that there is an issue with the organ, which is why until there is something serious like liver cancer, problems quite often go completely unnoticed.     Hepatitis or other types of liver inflammation account for up to 80% of primary liver cancers. This is why hepatocellular cancer is a serious problem, and it is the third leading cause of death from cancer worldwide.   What are the symptoms?   Symptoms don’t tend to appear until the liver is quite damaged, and the most common ones are:     Nausea and dizziness, which can lead to vomiting Intense abdominal pain Jaundice, which is yellowing of the skin due to high levels of bilirubin in the blood Itchy skin Fatigue Bruising and bleeding easily   Tests for liver diseases Liver diseases don’t tend to have symptoms, and the patient quite often only finds out that they have a problem when they are having tests for something else. Some of the tests used to detect and diagnose liver issues include.     Liver biopsy: a small needle is used to get a small sample of tissue to check for potential diseases.      CT scan: three dimensional imaging of the liver, to check for anomalies. Endoscopic retrograde cholangiopancreatography: is a technique that combines the use of endoscopy and fluoroscopy to check for any bile duct obstructions.    Ultrasound: to check the liver. Blood tests: are used to measure different substances in the blood. What causes liver diseases? There are different risk factors that increase the risk of developing liver disease, some include: Excessive alcohol consumption Injecting drugs Blood transfusion prior to 1992 Tattoos and piercings done in unregulated places Diabetes Obesity Prolonged exposure to chemical products Liver diseases can have different causes, such as infections, viruses, or parasites, as well as immune system anomalies, genetic problems, or substance abuse, among others.   How can they be prevented?    There are many recommendations to prevent liver disease, including: Drinking alcohol in moderation      Being vaccinated Being prudent with medications and avoid mixing them with alcohol    Avoiding other people’s bodily fluids Protecting skin            Avoiding obesity          What is the treatment?  Surgical resection: is carried out on patients with single, asymptomatic tumours and who have good liver function.    Liver transplant: in many cases this is the only option for patients with advanced liver disease.    Ablation: heat is applied to the tissue.         Chemoembolisation: is recommended for symptomatic patients who have unresectable carcinoma and who have a tumour that is too big to be treated with radiofrequency.  Certain liver diseases are treated in particular ways: Liver cancer: can be treated in different ways, depending on the tumour and the patient’s health.   Cirrhosis: there is no cure for cirrhosis, however there are certain steps that can be taken to slow and relieve symptoms such as; stop drinking alcohol, limit medication intake, and follow a balanced diet with fruits, vegetables, and cereals. Hepatitis: There isn’t a specific treatment for hepatitis A, and it will normally pass on its own within a couple of months, patients are recommended to eat less fats, avoid alcohol consumption, and rest. The recommendations for hepatitis B are similar to that of A, but there are also some medications that can keep the virus under control for many years. Treatment for hepatitis C tends to be a course of medication for between 30 to 48 weeks.    Fatty liver: in cases of non-alcoholic fatty liver the patient is recommended to lose weight and ensure they have a balanced diet. If it is caused by medications, you should stop taking the medication. For alcohol-related liver disease, you are advised to stop drinking alcohol.   What specialist should I see? Gastroenterologists and hepatologists (who specialise in the liver and conditions affecting it) can treat liver disease, although internal medicine specialists can also be consulted. ...

Liver function tests

What is a liver function test? Liver functions tests help diagnose and monitor liver disease by testing the blood. The tests measure the level of certain proteins and enzymes in the blood. Certain enzymes are released by the liver when it is damaged or diseased, and therefore it is helpful to measure these as an indicator. The same can be said for measuring proteins, such as bilirubin, which is a blood waste product that is usually cleared by a functioning liver. What does a liver function test involve? If your doctors recommends a liver function test, it is more than likely that a series of tests will be run which measure for different enzymes and proteins. During a liver function test, a sample of blood is taken through a small needle into a tube. The needle usually draws blood from the bend of your arm. Once a blood samples has been obtained, it will be sent to a laboratory for analysis, which can take either a few hours or a few days depending on whether the laboratory is located on-site or not.  What is a liver function test for? Typically, a liver function test is used to: Determine the severity of a disease, such as cirrhosis (scarring of the liver) Screen for liver infections (e.g. hepatitis) Measure the progression of liver disease, such as hepatitis, and to see how successful treatment is Check for any side effects to medications If you are experiencing the following symptoms, a liver function test will be carried out to help determine a diagnosis: Yellow eyes or skin (jaundice) Fatigue  Nausea Little appetite Dark urine and light-coloured stool How can you prepare for a liver function test? Before a liver function test food and drink has to be avoided for a certain period as these can affect the results. Certain medications will also have to be avoided before a liver function test.  What would a “bad” result mean? Normal results differ for men, women and children. When you receive your results, your numbers will display next to the normal, healthy range. If your results are not normal, further tests will be carried out to aid a diagnosis, or treatment plan. Ultimately, your specialist will explain your results and when the next steps will be.  ...

Primary biliary cholangitis (PBC)

What is primary biliary cholangitis (PBC)? Primary biliary cholangitis, otherwise known as primary biliary cirrhosis, or more commonly PBC is a liver disease, where the bile ducts become damaged. The bile ducts are important for carrying bile fluid from the liver to the stomach, used for breaking down and digesting food. PBC causes damage to the bile ducts, meaning bile fluid cannot travel through them, leading to a build-up of bile fluid in the liver, which in turn leads to cirrhosis of the liver. What are the symptoms? The symptoms are minimal or non-existent in the early stages, but can eventually lead to the following: Extreme tiredness (fatigue) no matter how much you rest Unexplained itchiness anywhere on the body (otherwise known as Pruritus). The itchiness doesn’t go away, even when you scratch it Dry mouth and dry eyes Pain in the upper abdomen PBC is often diagnosed following the diagnosis of a problem with the liver, which may be picked up following a routine blood test. What are the causes of PBC? The causes of this disease are not fully understood, however it is believed to be an autoimmune disease (a disease caused by the body’s natural reaction to an infection or disease), which occurs when the body mistakenly attacks the bile ducts. When the bile ducts are attacked, they become damaged, swollen, and scarring occurs meaning the bile ducts don’t function properly. Bile fluid is not able to flow, and becomes backed up in the liver, causing damage to the liver. Who is affected by PBC? PBC affects approximately 20,000 people in the UK, with around 90% of those affected being women aged between 40 and 60, though it can be diagnosed at any age. PBC affects more people on average in the UK, than in other parts of the world, though the reason for this is unknown. How is PBC treated? There is currently no known cure for PBC. The condition gradually gets worse over time, as the damage to the bile ducts becomes more extensive. There are certain medications available that slow the progress of the disease down. Medications are also prescribed to help with the itchiness associated with the disease.  ...

Primary sclerosing cholangistis (PSC)

What is primary sclerosing cholangitis (PSC)? Primary sclerosing cholangitis (PSC) is a chronic liver disease that affects the bile ducts. The disease causes inflammation and scarring in the bile ducts which causes the ducts to harden and narrow, affecting the transfer of bile liquid, which is used for digestion, from the liver to the small intestine. The disease eventually leads to cirrhosis of the liver, liver failure and can lead to bile duct cancer and liver cancer. What are the symptoms of PSC? PSC often doesn’t show symptoms, but some patients may experience debilitating symptoms of the disease. Symptoms to expect include: Itching (otherwise known as Pruritus). This is defined as severe, unexplained itching anywhere on the body that persists no matter how much you scratch Fatigue. Feeling tired all the time, even if you get lots of rest can be a symptom of liver damage or PSC Jaundice (yellow colour to the eyes and skin) Urine that is dark in colour Pain in the upper abdomen Fever and chills Weight loss   Causes of PSC There is currently no known cause of primary sclerosing cholangitis. It is thought that it could be an autoimmune disease, triggered by a reaction to an infection, though it does not respond to immunosuppressants. It is more common in people who have had inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease. Who is at risk from PSC? Primary sclerosing cholangitis can affect people of any age but is more common in those aged between 30 and 50 years of age. It is more common in men, and especially those with inflammatory bowel disease. How is PSC treated? No treatment has yet been developed, but there are a number of ways that the disease can be managed. The only long-term way of treating the disease is by liver transplant, although this is only done in a very small number of patients with PSC, and it is possible for the disease to return after transplantation. Some treatments are prescribed to relieve the symptom of itching, and antibiotics may be prescribed to treat acute episodes. Vitamin supplements may also be required, as the disease causes a lack of vitamins A, D, E and K. Surgery may be required in the form of balloon dilation or stenting to open up severe blockages in the bile duct. Patients with PSC will survive for an average of 21.3 years before either liver transplant is required, or they suffer a PSC-related death. ...

Second medical opinion

What is a second medical opinion? A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse. Why would you get a second medical opinion? Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease. In addition, there are certain situations where a second medical opinion is sought after: Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening The diagnosis is not clear-cut If you are considering a new treatment approach that is experimental The aims of obtaining a second medical opinion are: To confirm whether a diagnosis is correct and/or appropriate. To confirm whether a suggested treatment is correct and/or appropriate. To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure. Possible disadvantages of seeking a second medical opinion include: The process can delay the start of treatment. Logistically, seeing another specialist might be difficult and possibly time-consuming. It might be stressful to hear the same diagnosis again. How would you seek a second medical opinion? You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion. Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.  ...

Viral hepatitis

What is hepatitis? Hepatitis is the general term for inflammation affecting the liver, consequently causing it to function improperly. There are several kinds of viral hepatitis, including A, B, C, D, and E. Hepatitis can also be caused by drinking too much alcohol. There is also another form of hepatitis called autoimmune hepatitis, in which the immune system attacks the liver and damages it. What are the symptoms? Symptoms of hepatitis include: Cloudy urine Fatigue Febricula Itching Jaundice Loss of appetite Nausea or vomiting Weight loss Headaches Pharyngitis and cough Causes of hepatitis Hepatitis can occur for different reasons: Immune cells of the body that attack the liver Viral infections Liver damage caused by excess alcohol or toxins Overdose of medications such as for analgesics. Viral hepatitis can be passed on in different ways, depending on the type. For example, hepatitis B is common worldwide, but is not common in the UK, and it is spread through the blood of an infected person. Hepatitis D is another form of hepatitis which only affects those already infected with hepatitis B. Hepatitis C is the most common type of hepatitis in the UK. It is also transmitted through the blood of an infected person, and is most commonly transmitted through needle sharing when injecting drugs. Hepatitis E is on the increase in Europe and is passed on through raw or undercooked pork and offal. It can also be passed on through uncooked venison, shellfish, and wild boar. Can it be prevented? Hepatitis A and B can be prevented through a vaccine. To avoid getting hepatitis B and C, it is important not to share personal items such as razor blades, and make sure that proper hygiene protocol is followed if you are getting a body piercing or tattoo. Hepatitis A and E can be avoided by not consuming or using food or water that is not clean, washing hands thoroughly after going to the bathroom, and washing hands after being in contact with the blood, faeces or bodily fluids of an infected person. What is the treatment? The treatment varies according to the cause of the condition. The treatment for hepatitis A, for example, may simply be bed rest. In the case of hepatitis B, medication may be administered but only if chronic. Hepatitis C is treated through antiviral medications. Your hepatologist or specialist will advise on the best form of treatment, if necessary. In cases of liver damage, a transplant may be necessary. ...

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