Hepatology

We treat all forms of liver disease to include hepatitis C and hepatitis B, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, drug-related liver injury, cirrhosis and all of the complications related to advanced chronic liver disease. We also treat patients who have had liver transplants and medically manage post-liver transplant care. Although NMCSD is not a transplant center, we have very close working relationships with both liver transplant centers in San Diego and work together to ensure that liver transplant patients are properly managed.

Cirrhosis and liver transplantation

Cirrhosis is the end result of chronic liver disease and is caused by many different factors. The most common causes of cirrhosis in the United States are from hepatitis C, chronic alcohol use and non-alcoholic fatty liver disease. Many other diseases can lead to cirrhosis if left untreated such as hepatitis B, autoimmune liver disease and certain genetic conditions primarily affecting the liver; however, these are less common causes in this country.

Cirrhosis results from chronic inflammation of the liver cells (hepatocytes) resulting from exposure to a harmful agent, such as viral hepatitis or alcohol. Over a long period of time, scar tissue (fibrosis) can develop as a result of this inflammation. There are various stages of fibrosis, and cirrhosis is the most advanced form. Occasionally cirrhosis can go undiagnosed for long periods of time until complications develop. Many patients who have an early form of cirrhosis continue to have normal function of the liver and may not know they have liver disease. However, as the liver disease progresses, the liver function begins to deteriorate (or decompensate) to the point where the liver is no longer able to carry out it's primary duties in the body. It is at this point where liver transplantation may be the only option for complete cure. Sometimes removing the factors causing the liver disease can improve hepatic function to the point where liver function may improve and the patient may not need a liver transplant. This is specifically true for those who stop drinking alcohol or if the viral hepatitis is successfully treated. Unfortunately despite removing the causative agent, for some people liver transplantation is still necessary if the liver function does not improve.

Complications of Decompensated Cirrhosis include: 

• Ascites: Collection of fluid in the abdomen
• Varices: Accessory blood vessels in the stomach or esophagus that may bleed and require endoscopic intervention to help stop the bleeding
• Encephalopathy: Changes in mental status/confusion/concentration or sleeping habits that result from toxins not being cleared by the liver
• Hepatocellular Carcinoma: The most common form of liver cancer. All patients with cirrhosis are at risk of hepatocellular carcinoma and because of this, will need imaging of the liver every six months to ensure that suspicious nodules or lesions are not developing.