What we do
Hepatology is the branch of medicine that specialises in the prevention, diagnosis and management of diseases that affect the liver.
The liver is a vital organ within the abdomen which filters and cleanses all the blood leaving the stomach and intestines, and regulates many important components of our bloodstream (sugars, hormones, clotting factors, proteins etc).
A variety of conditions can lead to inflammation and progressive damage to the liver, and eventually, this can lead to a level of advanced scar tissue called ‘cirrhosis’. The conditions in question include damage from toxins (alcohol), metabolism (diabetes, obesity), viral infections (hepatitis B and C), autoimmune disorders and other rarer conditions affecting the metabolism and storage of vital minerals (iron, copper).
When cirrhosis occurs some patients develop further complications associated with ‘liver failure’ which can include yellow eyes/skin (jaundice), fluid in the abdomen (ascites), internal bleeding (varices), fatigue and confusion (encephalopathy), poor nutrition leading and, in some patients, liver cancer.
As Hepatologists we care greatly about identifying patients either at risk of liver disease or in the early stages, so that we can help to treat the problem affecting the liver and to avoid cirrhosis. For those patients diagnosed with more established liver damage we also specialise in managing all of the complications of cirrhosis and supporting patients through an often complex clinical journey.
The following information outlines more details on this service but is not exhaustive. There are a number of excellent patient support groups available for further advice and help but the main national charitable body which can help to inform and signpost patients to a variety of useful resources is the British Liver Trust:
Causes of liver disease
Alcohol related liver disease
The leading cause of damage in the western world is due to the toxic effects of alcohol. In many patients this is due to a long standing dependence and misuse of high level alcohol intake but in our experience we have also seen many cases of alcohol related damage which occur as a result of long standing steady ‘functional’ levels of intake. When combined with secondary risk factors like obesity or diabetes, liver damage can be accelerated. As a result, some patients can either not receive an early diagnosis or can avoid medical services entirely due to a perceived risk of stigmatisation or downplaying of risk factors. If you think your alcohol intake may be too high please consult with your GP in the first instance or take an online public health screening test to help make a risk assessment.
Locally there are a number of healthcare providers who specialise in supporting patients with alcohol dependency including: Change, Grow, Live.
Non-Alcohol related fatty liver disease (NAFLD)
Soon to become the leading cause for liver damage In the UK is a condition commonly known as ‘fatty liver’. Due to a combination of metabolic risk factors (obesity, diabetes, high blood pressure, high cholesterol) we know that patients can be at risk of depositing excess levels of fat onto their liver. In some patients this triggers an inflammatory reaction which leads to scar tissue forming (fibrosis). Over a long period of time this scar tissue can build up and lead to cirrhosis as well.
Therefore, it is very important that we raise wider awareness about the risk factors, and improving their basic management in the community, to try to avoid the significant population risk of developing fatty liver related cirrhosis and its related complications. Predominantly this condition can be screened for initially with blood tests and subsequently with Fibroscan and forms the cornerstone of our proposed new primary care referral guidelines for suspected liver disease.
Hepatitis is the term used to describe inflammation of the liver. It can be the result of a viral infection, autoimmune process or liver damage caused by drinking alcohol or chronic conditions like obesity or diabetes.
There are several different types of viral hepatitis:
- Hepatitis C
- Hepatitis B
- Hepatitis A, D, E,
Some types will pass without any serious problems, while others can be long-lasting (chronic) and cause scarring of the liver (cirrhosis), loss of liver function and, in some cases, liver cancer.
Hepatitis C is usually spread through blood-to-blood contact with an infected person. In the UK, its most commonly spread through sharing needles used to inject drugs.
Our service offers testing, treatment, education and appropriate on-going care (including liver cancer screening) for inpatients and community patients at risk of contracting the hepatitis C virus.
Our innovative community model aims to reach out to and engage vulnerable clients, including those who are affected by substance misuse and/ or those experiencing homelessness. Nationally we have led on development of novel and holistic community models of care to help achieve HCV elimination.
Peer Support in the community from the Hepatitis C Trust
The Hepatitis C Trust is a patient-led and patient-run organisation. If you have any reservations about Hepatitis C treatment, our peer support workers who have lived experience are here to help, for example, by answering questions or assisting patients to attend appointments for blood tests.
Hepatitis B is a virus that causes a potentially life-threatening liver infection. It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.
Hepatitis B is diagnosed using a blood test to look for the virus in the blood. Other blood tests to check how well the liver is working (liver function tests or LFTs) are also used both to diagnose the condition and monitor the effect of the virus on the body. Blood tests to measure the amount of virus in the blood (viral load) are also used for monitoring. When indicated we are able to provide Hepatitis B treatments within our services.
Hepatitis A is a virus that’s usually caught by consuming food and drink contaminated with the poo of an infected person, and is most common in countries where sanitation is poor.
Hepatitis A is usually self-limiting and passes within a few months, although it can occasionally be severe and even life threatening.
Hepatitis D is a virus that only affects people who are already infected with hepatitis B, as it needs the hepatitis B virus to be able to survive in the body.
Hepatitis D is usually spread through blood-to-blood contact or sexual contact. It’s uncommon in the UK, but is more widespread in other parts of Europe, the Middle East, Africa and South America.
Hepatitis E is a virus has been mainly associated with the consumption of raw or undercooked pork meat or offal, but also with wild boar meat, venison and shellfish. It is another infection which is usually self-limiting and short lived although can rarely cause a chronic infection.
Autoimmune liver disease
There are a number of conditions which are defined by a scenario where the body’s natural immune system is causing direct inflammation and damage to the liver system. Some are primarily due to inflammation of liver cells (Autoimmune Hepatitis – AIH) while others are due to inflammation of the bile ducts within the liver (Primary Biliary Cholangitis – PBC and Primary Sclerosing Cholangitis – PSC). Some conditions are due to an ‘overlap’ of more than one process and can be more complex and difficult to diagnose. We are able to provide detailed analysis of antibody testing, liver histology (biopsy) and other blood tests to help formulate a diagnosis and provide appropriate treatments.
Haemochromatosis is an inherited condition where iron levels in the body gradually build up over many years. In some cases this will lead to iron being deposited in the liver with associated inflammation and damage building up over time. In cases of liver disease associated with haemochromatosis we can arrange genetic testing, perform liver fibrosis assessments and initiate therapy.
A Fibroscan is a non-invasive medical device that assesses liver fibrosis and cirrhosis by measuring the degree of liver stiffness using ‘transient elastography’. It is quick, painless and easy to undertake and can provide a bedside assessment of underlying liver damage. The device also measures fatty changes to the liver and can help to quantify Non-Alcoholic Fatty Liver Disease (NAFLD).
Our service offers outpatient FibroScan clinics across all sites in the trust and we also offer a mobile outreach service across Sussex with our community hepatitis nurses.
Liver transplant, liver cancer and specialist working
Cirrhosis is scarring (fibrosis) of the liver caused by long-term liver damage. The scar tissue prevents the liver working properly. Your liver may keep working even when you have cirrhosis. However, cirrhosis can eventually lead to liver failure, and you can get serious complications, which can be life threatening.
Although we always endeavour to focus on treatment of the primary cause of liver damage, if our patient continues to deteriorate and they develop worsening liver failure the most definitive treatment is replacing the liver via transplantation.
If you are identified as in need of a liver transplant we have well established working relationships with Kings College Hospital Liver Transplant unit and will duly counsel you about this when needed.
Kings College Hospital outreach clinic
In line with this working relationship we also run a King’s College Liver Unit outreach clinic at Royal Sussex County Hospital every three months where a visiting transplant physician sits alongside Prof Verma or Dr Jamil to see selected patients with complex or rare conditions.
Hepatocellular Cancer (HCC) ‘Liver Cancer’
Primary liver cancer (Hepatocellular Carcinoma) is a recognised complication of long term cirrhosis and something that we proactively screen patients for with regular ultrasound scans and blood tests. When diagnosed, we care for patients with liver cancer in collaboration with colleagues at Kings College Hospital and Royal Surrey County Hospital, Guildford.
Sussex Hepatitis C Operational Delivery Network (ODN)
We host the Sussex Hepatitis C Operational Delivery Network (ODN), which was formed to ensure that all eligible patients are able to access specialist management and treatment for Hepatitis C (HCV).
The aim is to increase the number of patients who are treated and cured of HCV using the most clinically appropriate and cost effective options, in order to eliminate Hepatitis C as a public health issue by 2025, 5 years earlier than the World Health Organisation’s target of 2030.
The network aims to provide uniform and consistent service delivery through the use of standardised patient pathways and sharing best practice and experience.
Sadly, for some patients with very advanced disease who are not a candidate for liver transplant their condition can deteriorate and present quite a difficult and complex symptom burden.
Recognising that we cannot always cure everything and should instead focus our attention on symptom management, our clinical hepatology services have been innovative in developing close working relationships with our colleagues in palliative care to provide a much more sophisticated approach to managing the final stages of a patient’s illness. We have been recognised for this work nationally and shared our data with colleagues across the UK.
Advanced liver disease MDT’s are run monthly to oversee this patient group and we would invite you to raise this topic with your consultant if you have any questions or concerns about prognosis.
UHSussex has an active hepatology research programme led by Professor Sumita Verma and includes research fellows and academic F2 doctors.
Research is focused on HCV elimination by developing and evaluating community models of care for vulnerable adults (ITTREAT, VALID and END C studies), liver disease in people living with HIV (HEAL study) and refractory ascites in advanced liver disease (REDUCe 2 study). We are the recipients of grants from the National Institute for Health and Social Care (NIHR).
Referral information for GPs
Referrals for patients with Hepatitis C and B can be sent directly to the nursing team. We accept letters or you can complete and send us a referral form.
We are in the process of agreeing a new referral pathway for the management of abnormal liver blood tests which will include guidance and recommendations for a direct access Fibroscan service. This will allow for improved and more expedient primary care risk assessments for patients suspected of having metabolic and alcohol related liver damage.
- Types of Viral Hepatitis, NHS England
- Hepatitis B, World Health Organisation
- Liver Cirrhosis, British Liver Trust
- Liver Cancer, Cancer Research UK
- Liver Biopsy, British Liver Trust
- Help us eliminate Hepatitis C in Sussex, UHSussex Hepatology Nursing Team
- Hepatitis C Myth Buster, UHSussex Hepatology Nursing Team
- Hepatitis C Patient Referral Form, Sussex Hepatitis C ODN
- Autoimmune Hepatitis, British Liver Trust
- Primary Biliary Cholangitis, British Liver Trust
- Haemochromatosis UK
- British Liver Trust, contact: 0800 652 7330