Advanced liver care you can trust
At UTMB Health, our hepatology specialists care for patients with liver conditions ranging from fatty liver disease and hepatitis to cirrhosis and complex disorders. With advanced diagnostics, the latest treatments, and a team approach, we’re here to protect your liver health and improve your quality of life.
Conditions We Treat
Chronic Liver Diseases
Abnormal Liver Test
Overview:
Abnormal liver tests, often found during routine blood work, signal possible liver inflammation, injury, or dysfunction. Elevated enzymes may result from infections, alcohol use, medications, fatty liver disease, or other conditions. An abnormal result doesn’t always mean serious disease but usually requires further testing to identify the underlying cause.
Common Symptoms:
- Often no noticeable symptoms
- May vary depending on cause
Treatments & Procedures:
- Repeat blood tests for confirmation
- Ultrasound, CT, or MRI
- FibroScan (elastography)
- Blood tests for viral, autoimmune, or metabolic causes
- Medication adjustments if drug-induced
- Referral to hepatology for further evaluation
Alcohol-Related Liver Disease
Overview:
Alcohol-related liver disease develops after long-term heavy alcohol use, causing liver inflammation, fat buildup, scarring, and potentially cirrhosis. It is one of the most common causes of serious liver disease in the U.S. and worldwide. Risk increases with the amount and duration of drinking, though genetics and nutrition may also influence progression.
Common Symptoms:
- Fatigue
- Abdominal swelling
- Yellowing of skin and eyes
- Easy bruising or bleeding
- Nausea
Treatments & Procedures:
- Blood tests for liver function
- Imaging tests (ultrasound, CT, MRI)
- Alcohol cessation programs
- Nutritional support
- Medications to reduce inflammation or complications
- Liver transplant in severe cases
Cirrhosis of the Liver
Overview:
Cirrhosis is severe scarring of the liver caused by long-term damage from conditions such as hepatitis, alcohol use, or fatty liver disease. As scar tissue replaces healthy tissue, liver function declines, leading to serious complications, including bleeding from varices, portal hypertensive gastropathy, and hepatic encephalopathy. Although cirrhosis is often irreversible, early diagnosis and treatment can slow progression and improve quality of life.
Common Symptoms
- Fatigue
- Easy bruising or bleeding
- Jaundice
- Abdominal swelling (ascites)
- Itchy skin
Treatments & Procedures:
- Blood and imaging tests
- Endoscopy to check for varices
- Medications to manage symptoms and complications
- Lifestyle changes (alcohol cessation, diet)
- Regular cancer screening
- Liver transplant evaluation in advanced cases
Fatty Liver Disease
Overview:
Non-alcoholic fatty liver disease (NAFLD), now also referred to as metabolic associated fatty liver disease (MASLD), occurs when fat builds up in the liver without significant alcohol use. It is strongly linked to obesity, diabetes, and high cholesterol. It is one of the most common liver conditions worldwide and can progress to inflammation, scarring, or cirrhosis in some patients.
Common Symptoms
- Often no symptoms in early stages
- Fatigue
- Discomfort in the upper right abdomen
- Enlarged liver
Treatments & Procedures:
- Blood tests for liver enzymes
- Imaging (ultrasound, elastography)
- Weight loss and lifestyle changes
- Medications for associated metabolic conditions
- Regular monitoring for disease progression
Viral Hepatitis B, C, D, and E
Overview:
Hepatitis B, C, D, and E are viral infections that cause inflammation of the liver, varying in severity from acute illness to chronic disease. Transmission occurs through blood, bodily fluids, or contaminated food and water, depending on the virus type. Chronic infections can lead to cirrhosis, liver failure, or cancer. Early diagnosis and treatment are essential for preventing long-term liver damage.
Common Symptoms
- Fatigue or weakness
- Loss of appetite
- Nausea and vomiting
- Abdominal pain, especially in the upper right side
- Jaundice (yellowing of skin and eyes)
- Dark urine and pale stools
- Joint or muscle pain
- Fever (more common in acute infections)
Treatments & Procedures:
- Antiviral medications (for hepatitis B, C, and D)
- Direct-acting antivirals (for hepatitis C)
- Pegylated interferon (for select hepatitis B or D cases)
- Supportive care for acute hepatitis E and mild infections
- Regular monitoring of liver function and viral load
- Liver transplantation for severe or end-stage liver disease
- Vaccination (available for hepatitis B; protects against hepatitis D coinfection)
- Lifestyle modifications to protect liver health (avoid alcohol, maintain healthy weight)
Liver Masses & Cancer
Benign Liver Lesions
Overview:
Benign liver lesions are noncancerous growths, such as hemangiomas, focal nodular hyperplasia, or adenomas. They are often discovered incidentally during imaging for other reasons. Most do not cause symptoms or require treatment, but some may need monitoring or removal if large, painful, or at risk of bleeding. They are more common in women and may be linked to hormones.
Common Symptoms:
- Often no symptoms
- Abdominal discomfort if large
- Fullness or bloating
Treatments & Procedures:
- Imaging tests (ultrasound, CT, MRI)
- Blood tests to rule out cancer
- Observation with follow-up imaging
- Surgery if lesion is large, symptomatic, or suspicious
Hepatocellular Carcinoma
Overview:
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, usually developing in people with chronic liver disease or cirrhosis. Risk factors include hepatitis B or C, heavy alcohol use, and fatty liver disease. HCC is often detected through screening in at-risk patients and can be treated with surgery, ablation, or transplant if found early.
Common Symptoms
- Weight loss
- Abdominal pain or swelling
- Jaundice
- Loss of appetite
- Fatigue
Treatments & Procedures:
- Ultrasound and imaging scans (CT, MRI)
- Blood test for AFP (tumor marker)
- Biopsy in select cases
- Surgical removal or ablation therapies
- Targeted and immunotherapies
- Liver transplant for eligible patients
Liver Metastases
Overview:
Liver metastases occur when cancers from other parts of the body spread to the liver. They are more common than primary liver cancer and often arise from colorectal, breast, or lung cancer. The liver’s rich blood supply makes it a frequent site for metastasis. Treatment focuses on controlling cancer and managing liver-related complications.
Common Symptoms
- Abdominal pain
- Jaundice
- Weight loss
- Enlarged liver
- Fatigue
Treatments & Procedures:
- Imaging tests (CT, MRI, PET)
- Blood tests for liver function
- Biopsy if needed
- Chemotherapy or targeted therapy
- Surgery or ablation in select cases
- Supportive care for symptoms
Autoimmune & Genetic Liver Disorders
Autoimmune Hepatitis
Overview:
Autoimmune hepatitis is a chronic disease where the immune system mistakenly attacks the liver, causing inflammation and damage. It can affect people of all ages but is most common in women. Without treatment, it may progress to cirrhosis or liver failure, though many patients respond well to medications that control immune activity.
Common Symptoms
- Fatigue
- Jaundice
- Abdominal discomfort
- Joint pain
- Skin rashes
Treatments & Procedures:
- Blood tests for autoimmune markers
- Liver function tests
- Liver biopsy to confirm diagnosis
- Immunosuppressive medications (steroids, azathioprine)
- Long-term monitoring for disease activity
Hemochromatosis
Overview:
Hemochromatosis is a genetic disorder in which the body absorbs too much iron, leading to iron buildup in the liver and other organs. Over time, this excess iron can cause liver damage, diabetes, heart disease, and arthritis. It is most common in people of Northern European ancestry and is often detected through blood tests.
Common Symptoms
- Fatigue
- Joint pain
- Abdominal discomfort
- Darkened skin
- Diabetes (in advanced cases)
Treatments & Procedures:
- Blood tests for iron levels and genetic testing
- Liver biopsy or imaging for iron buildup
- Regular blood removal (phlebotomy)
- Medications to reduce iron levels if phlebotomy not possible
- Ongoing monitoring for organ health
Primary Biliary Cholangitis
Overview:
Primary biliary cholangitis (PBC) is a chronic autoimmune disease that slowly destroys the bile ducts in the liver. Over time, bile buildup causes inflammation, scarring, and cirrhosis. It primarily affects middle-aged women and is often discovered through abnormal blood tests before symptoms develop. Early treatment can slow progression and improve quality of life.
Common Symptoms
- Fatigue
- Itchy skin
- Dry eyes and mouth
- Jaundice (later stages)
Treatments & Procedures:
- Blood tests for antimitochondrial antibodies
- Liver function tests
- Ultrasound or elastography
- Medications (ursodiol, obeticholic acid)
- Symptom relief (itch management, supplements)
- Liver transplant in advanced disease
Primary Sclerosing Cholangitis
Overview:
Primary sclerosing cholangitis (PSC) is a chronic disease that causes scarring and narrowing of bile ducts, blocking the flow of bile. It often occurs with inflammatory bowel disease, especially ulcerative colitis. PSC can lead to cirrhosis, infections, or liver cancer. The exact cause is unknown, and it is more common in men than women.
Symptoms
- Fatigue
- Itchy skin
- Jaundice
- Recurrent fevers or chills (infections)
Treatments & Procedures
- Blood tests and imaging (MRCP, ERCP)
- Liver biopsy if needed
- Medications for symptom relief
- Endoscopic procedures to open bile ducts
- Regular cancer screening
- Liver transplant in advanced cases
Wilson's Disease
Overview:
Wilson’s disease is a rare genetic disorder that causes copper to accumulate in the liver, brain, and other organs. Symptoms often appear in childhood or young adulthood and can include both liver and neurological problems. Early diagnosis and treatment are crucial to prevent long-term damage, as copper buildup can lead to cirrhosis or neurological decline.
Common Symptoms
- Fatigue
- Abdominal swelling
- Tremors or difficulty speaking
- Mood or behavioral changes
- Jaundice
Treatments & Procedures:
- Blood and urine copper tests
- Eye exam for Kayser-Fleischer rings
- Liver biopsy
- Medications to remove copper (chelating agents)
- Zinc therapy to block copper absorption
- Lifelong monitoring and treatment
Other Conditions
Drug-Induced Hepatitis
Overview:
Drug-induced hepatitis is liver inflammation caused by medications, herbal supplements, or toxins. It may result from predictable effects (such as acetaminophen overdose) or unpredictable immune reactions. Severity ranges from mild enzyme elevation to liver failure. Identifying and stopping the offending drug is essential, and most people recover fully with appropriate treatment.
Common Symptoms:
- Fatigue
- Jaundice
- Nausea
- Abdominal pain
- Dark urine
Treatments & Procedures:
- Blood tests for liver enzymes
- Review of medications and supplements
- Imaging or biopsy if needed
- Withdrawal of the offending drug
- Supportive care and monitoring
- Liver transplant in severe cases
Learn more about liver conditions
Liver Disease with Unknown Cause
Overview:
Sometimes, patients develop signs of liver damage without a clear cause, even after thorough testing. This may result from rare disorders, early disease stages, or factors not yet understood. Specialists use advanced testing and ongoing monitoring to track changes and rule out known conditions. Management focuses on protecting liver health and preventing progression while searching for an underlying explanation.
Common Symptoms
- Fatigue
- Abnormal liver blood tests
- Jaundice
- Enlarged liver or spleen
- Abdominal swelling
Treatments & Procedures:
- Comprehensive blood testing
- Imaging (ultrasound, CT, MRI, elastography)
- Liver biopsy if needed
- Symptom management and monitoring
- Referral to specialized centers for evaluation
Portal Hypertension
Overview:
Portal hypertension occurs when scarring in the liver blocks normal blood flow, increasing pressure in the portal vein. It is most often caused by cirrhosis and can lead to serious complications like variceal bleeding, ascites, or splenomegaly. Management focuses on reducing pressure and preventing life-threatening events, often through medications, endoscopic therapy, or surgical procedures.
Common Symptoms
- Abdominal swelling
- Enlarged spleen
- Vomiting blood
- Black stools
- Confusion (hepatic encephalopathy)
Treatments & Procedures:
- Endoscopy to check for varices
- Blood tests and imaging
- Medications to reduce pressure
- Paracentesis for fluid buildup
- TIPS procedure (shunt placement)
- Liver transplant in severe cases
Services & Procedures
Endoscopic Treatment of Portal Gastropathy (Non-Variceal Bleeding)
Overview:
Endoscopic therapy for portal hypertensive gastropathy treats bleeding in the stomach lining caused by elevated portal pressure. Using an endoscope, physicians apply medications (like argon plasma coagulation or sclerotherapy) or thermal treatments to control bleeding and reduce recurrence, often alongside medications that lower portal pressure.
Conditions Treated:
- Portal hypertensive gastropathy (PHG)
- Non-variceal upper GI bleeding related to portal hypertension
- Chronic blood loss causing anemia in liver disease patients
Before the Procedure
Patients fast for 6-8 hours. Sedation or anesthesia is used. Blood tests check for anemia or clotting issues, and medications affecting bleeding risk may be adjusted.
After the Procedure:
Temporary sore throat or bloating may occur. Patients are monitored for rebleeding and usually start or continue beta-blocker therapy to reduce portal pressure. Normal diet is resumed as tolerated.
FibroScan (Transient Elastography)
Overview:
FibroScan is a quick, non-invasive ultrasound-based test that measures liver stiffness to evaluate fibrosis and fat accumulation. It provides an alternative to liver biopsy for assessing chronic liver disease progression. Results help predict the risk of cirrhosis and portal hypertension.
Conditions Evaluated:
- Chronic hepatitis B or C
- Fatty liver disease (NAFLD/NASH)
- Alcoholic liver disease
- Cirrhosis and fibrosis monitoring
Before and After the Test:
Patients fast for at least 2-3 hours. No sedation is required. Loose clothing allows easy access to the upper abdomen. Normal activity and diet can resume immediately after the test. Results are typically available the same day and help guide treatment or lifestyle recommendations.
Liver Function Test (LFT)
Overview:
Liver function tests are blood tests that measure liver enzymes, proteins, and substances to assess how well the liver is working. They help detect inflammation, damage, or impaired bile flow and are used for diagnosing and monitoring liver diseases or medication effects.
Conditions Evaluated:
- Hepatitis (viral, autoimmune, or drug-induced)
- Fatty liver disease (NAFLD/NASH)
- Cirrhosis or liver fibrosis
- Alcohol-related liver disease
- Biliary obstruction
Before and After the Test:
Usually no fasting is required, though some labs request fasting for 8-12 hours. Patients should inform providers of all medications and supplements, as some affect results. No restrictions are needed after the test. Results help determine liver health and guide further testing, such as imaging or biopsy, if abnormalities are found.
Non-Invasive Evaluation of Portal Hypertension
Overview:
Non-invasive evaluation of portal hypertension uses imaging and laboratory tools to assess increased pressure in the portal venous system without requiring direct catheterization. Techniques such as Doppler ultrasound, elastography (FibroScan), and MRI help estimate liver stiffness and blood flow, providing insight into liver scarring and the risk of complications like varices or ascites.
Conditions Evaluated:
- Cirrhosis and chronic liver disease
- Portal hypertension and its complications
- Nonalcoholic fatty liver disease (NAFLD/NASH)
- Hepatitis-related fibrosis
Before and After the Procedure:
No major preparation is usually required, though fasting for a few hours may be recommended. Patients should wear comfortable clothing and inform providers of any recent imaging studies or procedures. After the procedure, normal activities can resume immediately. Results are reviewed to guide treatment or monitoring. Findings may determine the need for endoscopy or further liver assessment.
Upper Endoscopy (EGD)
Overview:
An EGD, which stands for esophagogastroduodenoscopy. It is a medical procedure used to examine the lining of your upper digestive tract. This includes your
- Esophagus: The muscular tube that connects your throat to your stomach
- Stomach: The muscular sac where food is broken down
- Duodenum: The first part of your small intestine
The Procedure:
During an EGD, a doctor inserts a thin, flexible tube called an endoscope down your throat and into your digestive tract. The endoscope has a light and a tiny camera at the end, which allows the doctor to see the lining of your organs on a monitor. They can also use the endoscope to:
- Take tissue samples for biopsy (if needed)
- Remove small polyps or other abnormalities
- Treat certain conditions, such as bleeding ulcers
Preparing for the Procedure:
For an upper endoscopy, you’ll usually have to follow a clear liquid diet after midnight then, stopping all liquid consumption 2 hours before your scheduled arrival time. No solid food the day of procedure. Every patient is different so your gastroenterologist may have more specific instructions for you, if so, please refer to those if given.
Variceal Band Ligation
Overview:
Variceal band ligation is an endoscopic procedure used to treat or prevent bleeding from enlarged veins (varices) in the esophagus or stomach caused by portal hypertension. Elastic bands are placed around varices to cut off blood flow, leading them to collapse and heal.
Conditions Treated:
- Esophageal or gastric varices
- Active variceal bleeding
- Prevention of recurrent variceal hemorrhage in portal hypertension
Before the Procedure:
Patients fast for several hours. Sedation or anesthesia is used. Blood tests check coagulation, and medications that affect bleeding are managed as needed.
After the Procedure:
Mild chest discomfort or sore throat is common for a few days. A soft diet is recommended temporarily. Beta-blockers may be prescribed to reduce rebleeding risk. Follow-up endoscopy ensures varices are completely eradicated.
Vascular Procedures for Variceal Bleeding
Overview:
When endoscopic therapy is insufficient, interventional radiology–guided vascular procedures can control or prevent variceal bleeding. Techniques such as TIPS (transjugular intrahepatic portosystemic shunt) or embolization create new pathways for blood flow or block bleeding vessels, lowering portal pressure and reducing recurrence risk.
Conditions Treated:
- Refractory variceal bleeding
- Portal hypertension with recurrent hemorrhage
- Gastric or ectopic varices
- Complications of cirrhosis not controlled by medication or endoscopy
Before and After the Procedure:
You’ll be asked to fast for 6-8 hours before the procedure. Pre-procedure imaging assesses anatomy and portal pressure. Sedation or anesthesia is used, and blood thinners are paused. After the procedure, you’ll be observed for bleeding, infection, or encephalopathy is required. Liver function and portal pressures are monitored. Most patients recover within a few days and require ongoing follow-up for liver health and shunt function.
Your Care Team
Each provider may treat different conditions. Click on a profile to see their areas of specialty.
Frequently Asked Questions.
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When should I see a hepatologist?
You may need a hepatology evaluation if you have abnormal liver blood tests, unexplained jaundice, chronic hepatitis, or symptoms like persistent fatigue, abdominal swelling, or dark urine.
-
What tests are used to check liver health?
Common tests include blood work (liver function tests, viral markers, autoimmune tests), imaging (ultrasound, CT, MRI, FibroScan), and sometimes a liver biopsy.
-
Can liver disease be cured?
Some liver conditions are reversible if treated early, such as hepatitis C or fatty liver disease with lifestyle changes. Others can be managed to slow progression, while advanced cases may require liver transplantation.
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What lifestyle changes help protect the liver?
Avoiding excess alcohol, maintaining a healthy weight, exercising regularly, controlling diabetes or cholesterol, getting vaccinated for hepatitis A and B, and avoiding unnecessary medications or supplements can all protect liver health.
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How is hepatitis B different from hepatitis C?
Both are viral infections that damage the liver. Hepatitis B can often be controlled but not always cured; hepatitis C is now highly curable with modern antiviral treatments.
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When is a liver transplant considered?
A transplant may be recommended when the liver is too damaged to function properly, such as in advanced cirrhosis, liver failure, or certain cancers. UTMB Health specialists help patients through the evaluation and referral process.
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What should I bring to my first hepatology appointment?
Bring your medical records, a list of medications and supplements, prior test results, and details about alcohol or medication use. This helps your care team understand your health history and provide the best care.
All Gastroenterology Specialties
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