Educational programme in hepatology

Nowadays, hepathology is a highly specialized part of the internal medicine. A lot of various specialists, like hepatho-gastroenterologists, pediatricians, epidemiologists, biochemists, surgeons, doctors who are engaged in drug addict treatment, pathologists and, at last, general practitioners (family doctors) and nurses work at those institutions. Education in this branch of science requires highly competent, skillful doctors, experts in all levels: from public-health institutes to hepathological clinics, hospitals and wards. Besides, it is necessary to keep files on the diseases, to record symptoms, the historical data and all therapeutic measures applied in every kind of pathology. Such teams must study well all the ways of preventing hepathological disease occurrence, especially with referral to “hepathotropic” viruses, alcoholism, drug addiction etc. Firstly, the Faculty of Medicine is responsible for putting into effect the educational program in hepathology. The great knowledge of etiology, pathogenesis, biochemical and immunological parameters, as well as histopathological and diagnostic definition is studied at the Faculty. This program requires good communication with epidemiological services in our country and abroad in order to follow cosmopolite and local spread of those diseases (possible epidemics), especially if they are chronic kinds of hepatitis caused by viruses (B.C, D, G, E, A). Besides, the frequency of HCC occurrence must be observed and the up to date therapy must be applied. Complete understanding of this pathology requires the knowledge of biochemical and biological diagnostic tests which are performed by biochemists from highly specialized laboratories (all the test lines by PCR techniques), along with immunological and immunobiological tests which also define the diagnosis in this domain. Liver biopsy is obligatory diagnostic procedure for hepatologists, besides, they must know well all contraindications of this method, which helps us to get precise pathological diagnosis of this disease. Epidemiologists are of great importance in prevention and treatment and also in vaccination of the patients, with a special concern about patients suffering from a virus infection. Education must not omit either good knowledge of indications of liver transplantation as the only definite therapeutic measure in hepathology. Also, hepathologist must know the moment when to tell the patient that the only possible way of recovering is liver transplantation. Our financial abilities and limitations in applying definite therapeutic measures must not be an obstacle in informing the patient what would recover him from his chronic disease.

PHASES OF EDUCATION:

1. The Faculty of Medicine, where in the frame of studies, hepathology is present in the anatomy, histology, patho-anatomy, biochemistry, infectious diseases, pediatrics, internal medicine, surgery, epidemiology and other courses.

2. Internal medicine specialization, where the studies of hepathology have important place.

3. Sub-specialization and M.A. degree in gastroenterology and hepathology including a defense of the dissertation in hepathology.

4. To study for the doctorate with an advisor competent in hepathology and finally to defend the dissertation in this domain which includes recent achievements in liver pathology.

5. National and international symposiums and congresses on gastroenterology and hepatology. National and international symposiums and congresses on infectious hepatitis.

6. SLD sections: hepathology section, gastroenterology section, infectology section, pediatrics section and surgery section.

7. Lectures at the public-health protection institutes in order to educate family doctors in this domain.

8. Lectures at school; education; preventing diseases, including discussion about hepatitis, sexually transmitted diseases, drug abuse and alcohol addiction.

9. Giving lectures and cooperate with pharmaceutical institutions, which are representatives of some remedies and preparations for hepathological diseases. It is performed by Public-health care institute, by Clinical centres and by hospitals which enables patients to be better informed and have the most contemporary treatment.

10. Advertising in media about the protection and prevention from spreading viral hepatitis, from drug abuse and alcohol addiction as well as propaganda of giving organs necessary for liver transplantation.

Finally, it must be noted clearly that hepathology presents the domain of close cooperation between hepathologist and gastroenterologist, infectologist, laparascopic or general surgeon, pediatrician, hemathologists, immunologists, rheumatologists, biochemists and epidemiologists. So, the teams of specialists must observe and treat the above mentioned diseases. Universality of all scientific disciplines helps hepathologists follow their vocation to become successful doctors.

Hepatologija danas predstavlja visoko specijalizovani deo interne medicine i ovim domenom se bave hepatolozi-gastroenterolozi, infektolozi, pedijatri, epidemiolozi, biohemičari, hirurzi, lekari u ustanovama za lečenje zavisnosti, patolozi, i, najzad, lekari opšte prakse i medicinske sester koje rade u tim ustanovama. Edukacija iz ove oblasti zahteva kompletne lekare, kompetentne na svim nivoima – od Domova zdravlja do hepatoloških klinika, bolnica i odeljenja uz vodjenje dobre evidencije ovih oboljevanja sa prepoznavanjem simptoma, kliničke slike i svih najnovijih terapijskih mera u lečenju ove patologije.Ovakvi timovi moraju imati dobro poznavanje preventivnih mera u nastanku hepatoloških bolesti posebno u odnosu na hepatotropne viruse, alkoholnu bolest, zavisnost od droge itd. Za dobro postavljanje programa edukacije iz hepatologije pre svega je zadužen medicinski fakultet gde se tretira poznavanje etiologije, patogeneze, kliničke slike, biohemijskih i imunoloških parametara kao i patohistoloških nalaza u definisanju dijagnoze. U ovom programu neophodan je dobar kontakt sa epidemiološkim službama kod nas i u svetu, kako bi se dobro poznavalo kosmopolitsko i regionalno kretanje ovih bolesti (moguće epidemije), posebno kada su u pitanju virusima izazvane hronične hepatopatije (B,C,D,G,E,A). Takodje se mora pratiti učestalost pojave HCC uz poznavanje mogućnosti najsavremenije terapije. Kompleksno poznavanje ove patologije zahteva i poznavanje biohemijskih i bioloških dijagnostičkih testova koje rade biohemičari iz visoko specijalizovanih laboratorija (sve linije testova PCR tehnikom), uz imunološke i imunobiološke testove koji takodje odredjuju dijagnozu u ovom domenu. Biopsija jetre je obavezna dijagnostička procedura za hepatologe uz dobro poznavanje kontraindikacija za ovu metodu čime nam ona omogućava dobijenja tačne patohistološke dijagnostike ove patologije. Infektolozi imaju veliki značaj u prevenciji i lečenju ali i vakcinaciji pacijenata kada su virusni bolesnici u pitanju. Edukacijom se ne sme preskočiti ni dobro poznavanje indikacija i primene transplantacije jetre kao jedine definitivne terapijske mere u hepatologiji. Naime, hepatolog mora znati trenutak kada se pacijentu saopštava da je jedino moguće izlečenje transplantacijom jetre. Naše materijalne mogućnosti i limitiranost u primeni odredjenih terapijskih mera ne sme biti smetnja da pacijent dobije pravi odgovor šta vodi izlečenju njegove hronične bolesti.

FAZA EDUKACIJE:

1. Medicinski fakultet, gde je u okviru studija hepatologija prisutna u okviru anatomije, histologije, patoanatomije, biohemije, infektivnih bolesti, pedijatrije, interne mediciine, hirurgije, epidemiologije itd.

2. Specijalizacija interne medicine, gde hepatologija ima značajno mesto izučavanja

3. Subspecijalizacija i magisterijum iz gastroenterologije i hepatologije sa odbranjenim radom iz domena hepatopatija.

4. Doktorske disertacije sa mentorstvom dokazanog stručnjaka iz ovog domena i odbranom rada koji donosi najnovija dostignuća iz patologije jetre.

5. Simpozijumi i kongresi u zemlji i inostranstvu iz gastroenterologije i hepatologije, simpozijumi i kongresi iz infektivnih hepatitisa u zemlji i svetu.

6. Sekcije SLD-a: hepatološka, gastroenterološka, infektološka, pedijatrijska i hirurška.

7. Predavanja u Domovima zdravlja radi edukacije lekara opšte prakse iz ovog domena.

8. Predavanja u školama; edukacija; prevencija oboljevanja sa osvrtom na virusne hepatitise, seksualno transmisivne bolesti kao i na drogu i alkohol.

9. Predavanja i saradnja sa renomiranim farmaceutskim kućama, koje su zastupnici pojedinih lekova i preparata za hepatopatije i to ostvareno od Domova zdravlja o Kliničkih centara i bolnica, čime se dobija dobra obeveštenost i najsavremenije lečenje ovih bolesnika.

10. Propaganda u medijima za zaštitu i prevenciju od virusnih hepatitisa; protiv konzumiranja alkohola, protiv zloupotrebe droge i propaganda za davalaštvno organa koji su neophodni za transplantaciju jetre.

Najzad, mora se jasno označiti da hepatologija predstavlja domen tesne saradnje hepatologa – gastroenterologa, infektologa, laparoskopskih i opštih hirurga, pedijatara, hematooga, imunologa, reumatologa, biohemičara i epidemiologa, pa se timski moraju pratiti i lečiti ovi bolesnici. Sveobuhvatnost svih disciplina omogućava ostvarenje dobrog pristupa osnovnoj vokaciji lekara hepatologa.