Hepatology

Overview

Fellows are exposed to general hepatology during inpatient consult service, outpatient liver clinics, and during their fellow’s continuity clinics.

In the second year of fellowship, 3 months are dedicated to transplant hepatology (a combination of inpatient and outpatient). This rotation provides an intensive and focused multidisciplinary approach to pre- and post-transplant patients with liver diseases. Our transplant team averages about 70 transplants a year. In 2024 they did 14 transplants with living donors.

The fellow also has a supervisory and teaching role for medical residents and/or students on the hepatology rotation.

Principal Teaching/Learning Activities

• Fellows regularly participate in inpatient multidisciplinary teaching rounds with attending transplant hepatologists, surgeons, and other specialists in the care of imminently pre-liver transplant patients, as well as exposure to peri-transplant clinical care.
• They also participate in daily bedside clinical rounds on hepatology patients and are involved in the management decisions of their care. Write regular progress notes to reflect the discussion and care of the patients.** Note that fellows do not participate in the writing of direct patient orders (advanced practice providers and hospitalists on the hepatology service write orders).
• Fellows perform any inpatient hepatology procedures under the direct supervision of transplant hepatology attending.

• Fellows will attend weekly outpatient pre-transplant liver clinic.  Preparation will involve review of all relevant clinical data and direct evaluation of liver transplant candidacy of these patients and will be supervised by the transplant hepatology attending. Fellows will formulate comprehensive notes reflective of the content and discussion and subsequently present the patients to the multidisciplinary liver transplant selection committee that meets weekly.

Problem Mix / Patient Characteristics / Types of Encounters

The fellow is exposed to a wide variety of liver diseases:

• Acute and chronic viral hepatitis
• Alcoholic hepatitis
• Autoimmune hepatitis
• Cholestatic liver diseases (primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced liver disease, etc.)
• Fatty liver disease and metabolic associated steatosis 
• Hemochromatosis
• Wilson’s disease
• Alpha-1 antitrypsin deficiency
• Infiltrative liver diseases
• Inpatients of various levels of clinical acuity, as well as ambulatory outpatients, are seen
• Complications of cirrhosis, including bleeding of portal hypertensive origin, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, coagulopathy, fulminant hepatic failure, and hepatopulmonary complications, will be encountered.