Specialists in the liver disease section of the Department of Gastroenterology manage and treat the full range of liver diseases, as well as identifying and managing patients before and after liver transplants. They work closely with interventional radiologists in a wide range of leading-edge diagnostic and treatment techniques. Washington University School of Medicine also has one of the top liver transplant teams in the country.
FOR APPOINTMENTS, CALL: 314-747-2066 OR 800 858-3541
Specialists in hepatology include:
Jeffrey S. Crippin, M.D., co-director
Mauricio Lisker-Melman, M.D., co-director
Kevin Korenblat, M.D.
Tom Kerr, MD, PhD
Jaquelyn Fleckenstein, MD
Patients are seen at:
Center for Advanced Medicine
GI Center
4921 Parkview Place, Suite C, Floor 8
St. Louis, MO 63110
Common Liver Diseases
Liver Cirrhosis
Cirrhosis refers to the replacement of normal liver tissue with non-living scar tissue, due to other liver diseases. Cirrhosis is a potentially life-threatening condition that causes liver failure if the process of cirrhosis is not slowed or stopped. About 40 percent of the 26, 000 people who die from cirrhosis each year have a history of alcohol abuse. Cirrhosis can also be due to chronic viral hepatitis, autoimmune liver disease, non-alcoholic fatty liver, bile duct disease, drug-induced liver toxicity, and metabolic liver disease. Liver failure can result in:
Gastrointestinal bleeding
Ascites
Hepatic encephalopathy
Jaundice/pruritis
Acute Liver Failure
This is a sudden onset liver injury with no pre-existing liver condition. It is life-threatening and may result in coma in later stages. It may be due to a viral infection, drug toxicity, or an autoimmune response.
Viral Hepatitis: Hepatitis A, B, and C
Hepatitis means an inflammation of the liver. Hepatitis A, B, and C are caused by viruses. While A and B are somewhat easy to recover from by most people, Hepatitis C is the second leading cause of cirrhosis. About one in four people with chronic hepatitis C develop cirrhosis. Chronic hepatitis C is a serious condition that can lead to potentially fatal liver diseases such as cirrhosis, liver failure and liver cancer. One of the most common reasons for liver transplants is damage caused by hepatitis C infection. It is responsible for 8,000-10,000 deaths annually.
Autoimmune liver disease
Autoimmune hepatitis causes the body’s own immune system to attack the liver and make it become inflamed. The disease is chronic, meaning it lasts many years. If untreated, it can lead to cirrhosis and liver failure.
Primary biliary cirrhosis (PBC): This is a chronic, or long-term, disease of the liver that slowly destroys the medium-sized bile ducts within the liver. Bile is a digestive liquid that travels through the bile ducts from the liver to the small intestine, where it helps digest fats and fatty vitamins. When the bile ducts are destroyed by inflammation, the bile remains in the liver, damaging liver cells and causing cirrhosis, or scarring of the liver.
Primary sclerosing cholangitis: This is a chronic disease that slowly damages the bile ducts inside and outside the liver. Bile ducts become blocked due to inflammation and scarring, causing bile to accumulate in the liver, where it gradually damages liver cells and causes cirrhosis.
Alcoholic liver disease: The most common cause of cirrhosis in the United States is chronic alcoholism. The liver breaks down alcohol into toxic chemicals, some of which trigger the inflammation that leads to cirrhosis. Nearly everyone who drinks excessively suffers some liver damage, and between 10 and 20 percent of heavy drinkers develop cirrhosis.
Non-alcoholic fatty liver disease (NASH): Excess fat in the liver leads to inflammation, which can eventually cause cirrhosis. NASH is often linked to diabetes, obesity, coronary artery disease and protein malnutrition.
Drug-induced liver toxicity, such as that caused by acetaminophen.
Metabolic liver disease Wilson’s Disease, an abnormal accumulation of copper in the liver Hemochromatosis, an abnormal accumulation of iron in the liver Alpha 1-antitrypsin deficiency, the absence of a specific liver enzyme Glycogen storage diseases, which prevent the body from properly using sugars
Liver Procedures
The most up-to-date diagnostic procedures are available to liver specialists working in conjunction with Washington University interventional radiologists.
Procedures include:
Liver biopsy: In a typical liver biopsy, a needle is inserted through the rib cage or abdominal wall. The needle goes into the liver to take a sample for examination.
Transjugular liver biopsy: The procedure can also be performed by inserting a needle into the jugular vein. A catheter is then passed through the veins, down to the liver, to take the sample
Transjugular intrahepatic portosystemic shunt (TIPS): The transjugular intrahepatic portosystemic shunt TIPS is a radiologic procedure in which a stent (a tubular device) is placed in the middle of the liver to reroute the blood flow. During the procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (the three veins that carry blood from the liver).
A metal stent is placed in this tunnel to keep the track open. It is used to treat portal hypertension, a condition characterized by increased pressure in the portal vein. The increase in pressure is caused by a blockage in the blood flow throughout the liver. The TIPS procedure is used to manage the complications of portal hypertension, including: Variceal bleeding, varicose veins that develop (usually across the esophagus and stomach) when there is a blockage in the blood flow throughout the liver; and ascites - an accumulation of fluid in the abdomen.
Abdominal paracentesis: During this procedure, a needle is inserted through the skin to remove fluid from the abdomen. Normally, the abdomen contains only a small amount of fluid. In certain conditions, large amounts of fluid can accumulate.
Radiofrequency ablation: A treatment technique that uses high-frequency alternating electrical current to destroy tissue cells, such as liver tumors, by heating them.
Targeted cryoablation therapy: Cryotherapy is the use of extreme cold for the treatment of disease.
Some liver conditions can lead to liver failure and the need for a liver transplant.