Of Overcoming Ignorance

Today, day three at the hospital, I feel I am finally getting the hang of Hepatology!

Dr. Miloh sat down with me and had me sign off the skills I acquired on a, shocker, Skills Acquired worksheet that the hospital keeps for their records, and I was proud to be able to sign off on 'basic knowledge of Hepatology and Gastroenterology.'

Today, I was able to fly through three hundred more names, putting me at 500 out of 636. I also had time to get back to Scottsdale in time to hike Sunrise Peak before dark, which was absolutly gorgeous in the sunset.

With every case study I read, I become more used to the formatting the doctors use. I know exactly which ones use the dreaded One Paragraph Method, and which ones kindly break up the document into skimmable sections. The best MD though, is the Hepatologist. He writes all his diagnoses at the end of the page, so that it is extremely easy to find the right one once one gets accustomed to the usual diseases.

I can now discern most of the recurring Hepatological diagnoses, and can usually tell when a diagnosis does not pertain to a liver disease. I can now also quickly scan an entire study to find the diagnosis. I feel like a voyager slowly walking out of Plato's Cave. Ah, the feeling of ignorance being conquered is nice.

Here are some of the most common diseases I deal with:

NAFLD (Non-Alcoholic Fatty Liver Disease). This diagnosis is reserved for patients whose problems stem from obesity or extreme overweightedness. Often, their cases are sent in conjunction to the Psychology Department, where a licensed psychologist works with the patients to get them to change their habits, and explains to them the severity of their situation. These cases have similar "plans of attack" that seek first to help the patient loose weight through a strict diet and exercise plan. When asking Dr. Miloh if many patients loose enough weight to become healthy again through the hospital, he stated that though some seem insistent on staying the way they are, a much more significant amount lose enough weight to avoid surgery, and many acquire a healthy weight in the end.

Chron's Disease. This diagnosis often comes from the general Gastro department, and not the Hepatology department. The disease affects the intestines and the inner tube of the body that leads from the mouth to the rectum. It is basically an inflammatory disease that leads to liver complications, and treatment of Chrons will often remove any underlying liver problems.

Hepatitis, Hepatitis B (HBV) , Hepatitis C (HCV), and Autoimmune Hepatitis (AIH). Hepatis is the swelling and inflammation of the liver, and caused by a viral infection. Each type of Hepatitis comes in many flavors. The one I have dealt with have been Genotype 1, Genotype 1a and 1b, Genotype 2, Genotype 2a, and Genotype 2b. Hepatitis (in all its many flavors) is one of the main causes of lliver cancer, and consequentially many patients suffering from the disease get liver transplants. Some, however, especially those with "acute" and not "chronic" hepatitis, do get better without transplants. Additionally, I found one case study with states that there is a 50% spontaneous recovery rate amongst adolescents, which is quite impressive. While HBV and AIH originated mostly in the body, HCV often is transmitted via unclean needles, drug abuse, and through sexual transmission. This seems to be the most problematic flavor of this disease. However, HCV can also be simply a mutation in the body like HBV and AIH. There is no cure for Hepatistis currently. Looking at the case results, it seems most HBV patients get better or learn to live with their disease, while most HCV patients need a liver transplant, and it is heavily stressed that they discontinue any use of needles and make sure to cover all wounds in the skin, no matter how small.

Bilary Artesia. Most patients with this come to Phoenix Children's as a result of a liver transplant. From what I have encountered, Biliary Artesia seems to be one of the forefront reasons for patients to get a liver transplant. In this disease, the ducts that cary bile from the liver to the gallbladder become blacked. It is most often characterized my Jaundice (yellowing of the skin). In many cases, especially if the patients are diagnosed as infants, a Kasai procedure will be done to avoid a liver transplant. The Kasai procedure connects the liver to the small intestine, so to bypass the gallbladder completely.

Wilson's Disease. This is a very interesting and very rare disease, but it seems that pretty frequently patients visiting the GI will have (it was also featured on an episode of House if you are interested in some Med Drama). In Wilson's, copper builds up in the liver, as well as the brain, eyes, and other organs. It is a genetic disease, caused by a mutation in the ATP7B gene. The reason the copper (which in large amounts is poisonous) build up is because the liver becomes ineffective in removing it.

There are many more diagnosis’s I work with, but the above are the most common.

Hoping you are all keeping your livers in check! Best,

Lior