Questions to Ask Your Liver Specialist: A Hepatologist’s Guide to the First Visit
Bring every report, every imaging CD and every tablet, syrup and herbal powder you take — then ask five things: what is causing my liver disease, what stage is it (FibroScan), is it reversible, which medicines must I avoid, and when do I need endoscopy, liver cancer screening or a transplant opinion. A hepatologist is a physician trained specifically in liver disease; in India that is the DM in Hepatology.
— Dr Chetan Kalal, DM Hepatology, Gleneagles Hospital Mumbai
Key takeaways
- A hepatologist’s entire training is the liver, biliary system and liver transplant medicine; the DM in Hepatology is the super-specialty degree in India.
- A good consultation starts with a complete file: blood reports in date order, imaging CDs, and an honest list of every medicine, supplement and herbal preparation.
- Newly diagnosed? Three questions: what is the cause, what stage is the scarring, is it reversible.
- Cirrhosis? Ask whether you need an endoscopy for varices and whether you are on six-monthly liver cancer surveillance — both are guideline-standard.
- Ask before taking any painkiller: anti-inflammatory tablets (NSAIDs) are advised against in cirrhosis with ascites.
Most patients walk into a liver clinic with one question: “Is it serious?” Fair, but it is the wrong one to lead with, because the honest answer depends on five or six things nobody told them to ask about. This guide explains what a hepatologist is, what to carry to the first visit to a liver doctor, and which questions — grouped by your situation — get the most out of twenty minutes with a specialist.
What does a hepatologist do, and when should you see one?
A hepatologist is a physician trained specifically in diseases of the liver, bile ducts and gallbladder, and in the medical side of liver transplantation. In India the route is a DM in Hepatology, a three-year super-specialty degree after MD Medicine. A gastroenterologist (DM Gastroenterology) trains across the whole digestive tract, liver included, and many manage liver disease very well. The difference is depth and focus, not competence: hepatology is the full-time study of one organ, including transplant selection and care before and after the operation.
My own training was the DM in Hepatology at ILBS, New Delhi, under Prof S. K. Sarin, which made me the first DM Hepatologist in Maharashtra. Since then my team has been involved in more than 1,000 liver transplants — roughly 300 of them complex — with 92% survival. I mention this only to explain the lens of this article: it is written from the transplant end, where I see what happens when questions were not asked early enough. More on my background here.
When should you see a hepatologist rather than your physician? Liver enzymes that stay abnormal for months; an ultrasound mentioning “coarse echotexture”, cirrhosis, portal hypertension or an enlarged spleen; hepatitis B or C; fatty liver with diabetes or a raised FibroScan; unexplained jaundice; and, without exception, anyone who has had ascites, vomited blood or had an episode of confusion. Your family physician stays central — the hepatologist adds the organ-specific plan.
What to bring to your first visit to a liver doctor
Half of a good consultation happens before you enter the room.
Every report, in date order. Liver tests going back years show the trajectory; one result cannot. Include platelets, INR, creatinine, HbA1c and lipids — liver disease is rarely a liver-only problem.
Imaging CDs, not just printed reports. The report says “fatty liver, grade 2”; the images may show surface nodularity or a large spleen that nobody asked the radiologist about. If you have had a FibroScan, bring the printout with the stiffness (kPa) and CAP values.
A written list of every medicine — prescription, over-the-counter, ayurvedic, unani, homoeopathic, bodybuilding supplements, “liver tonics”. In India, herbal and over-the-counter preparations are a leading cause of drug-induced liver injury, and the patient who leaves them off the list because they are “natural” delays their own diagnosis. Bring the bottles if unsure of the names.
An honest alcohol history. Amount, pattern, years, date of the last drink. It changes nothing about how you are treated as a person; it changes only the accuracy of the diagnosis.
Family history of liver disease, liver cancer, hepatitis B, diabetes or autoimmune disease, plus your own history of jaundice, transfusion, surgery or tattoos.
The questions, grouped by your situation
You will not need all of these. Find the row that fits you.
| Your situation | The three questions to ask |
|---|---|
| Just diagnosed with a liver problem | 1. What is the cause — fat, alcohol, a virus, a drug, an immune or genetic condition? 2. What stage is my liver — how much scarring (fibrosis), and does my FibroScan reading tell you that? 3. Is it reversible, and over what timeframe? |
| Told I have cirrhosis | 1. Am I compensated or decompensated, and what is my Child-Pugh and MELD score? 2. Do I need an endoscopy to look for varices, or do my FibroScan and platelet count let me avoid one? 3. Am I on six-monthly ultrasound (with or without AFP) for liver cancer surveillance? |
| Starting or reviewing treatment | 1. Which of my current medicines are safe for my liver, and which must stop? 2. What should I take for pain or fever — and is it true that I should avoid NSAIDs? 3. Which vaccines do I need (hepatitis A and B, influenza, pneumococcal)? |
| Transplant has been mentioned | 1. Am I a candidate, and what score or event would make you refer me? 2. Should I be evaluated now so I am not referred too late? 3. Living donor or deceased donor — what does the process look like for my family? |
| Lifestyle and daily living | 1. What should I eat — and is there any protein restriction (usually no)? 2. Is any amount of alcohol acceptable for me? 3. What exercise is safe, and how do I protect my muscle mass? |
Two rows deserve a word more. If you are newly diagnosed, the cause decides everything that follows — fatty liver, alcohol, hepatitis B or C, autoimmune hepatitis and Wilson disease are treated in entirely different ways, yet many patients leave a clinic knowing only that their “SGPT is raised”. Stage comes next: fibrosis runs from F0 to F4 (cirrhosis), and a FibroScan estimates it without a biopsy. Early fat and inflammation are often reversible; established cirrhosis can stabilise, but the goal shifts to preventing complications. My fatty liver page covers the commonest version of this conversation.
If you have cirrhosis, two questions change management the most. Varices first: international consensus (Baveno VII) lets some patients with compensated cirrhosis skip endoscopy when liver stiffness and platelet count are both reassuring; everyone else needs one. Then liver cancer. The American (AASLD, 2023) and European (EASL, 2025) liver societies both recommend surveillance ultrasound every six months in cirrhosis, because cancer caught at that interval is usually still curable. If nobody has put you on a six-monthly schedule, that is the most important sentence on this page. Ascites, encephalopathy and nutrition are covered on my cirrhosis page.
Medicines, vaccines, transplant and lifestyle
Painkillers. The commonest avoidable harm I see is a patient with cirrhosis taking an anti-inflammatory tablet — an NSAID such as ibuprofen or diclofenac — for a knee or a fever. The European guideline on decompensated cirrhosis (EASL, 2018) advises against NSAIDs in patients with ascites because they can precipitate kidney failure and fluid retention. Ask what you may take instead, and at what limit; the answer is individual, and this article deliberately gives no doses.
Other medicines. Go through the list drug by drug: “safe, adjust, or stop?” Diabetes tablets, statins, tuberculosis therapy, antiepileptics and herbal products each need a specific answer.
Vaccines. Hepatitis A and B (if not already immune), influenza and pneumococcal vaccination are standard advice in chronic liver disease. Ask which you have had and which you need.
Transplant. The question is not “do I need a transplant?” but “when should a transplant team see me?” Late referral is the pattern I most want to change. After any decompensation — ascites, variceal bleeding, confusion — or a rising MELD, ask for a transplant evaluation now, even if the operation is years away or never needed. Evaluation is not commitment.
Lifestyle. Ask about diet in specifics — protein target, salt, a late-evening snack — because outdated advice to restrict protein still circulates and causes muscle loss. Ask whether any alcohol is acceptable (for most liver disease, none). Ask what exercise is safe; resistance training to protect muscle is usually encouraged, not forbidden.
One habit that improves every visit
Write the questions down before you come and the answers down before you leave. Ask for your numbers — FibroScan kPa, platelet count, MELD, Child-Pugh — and keep them in one place, so the next visit begins with “has it changed?” rather than “what is it?” A patient who tracks three numbers over a year understands their liver better than one who has been told “it’s a bit high” ten times.
Frequently asked questions
What is the difference between a hepatologist and a gastroenterologist?
A gastroenterologist trains across the whole digestive system, including the liver. A hepatologist trains in the liver, bile ducts and liver transplant medicine alone — in India through a DM in Hepatology. Both can manage liver disease; a hepatologist is the natural choice for cirrhosis, complex or unexplained liver disease, and transplant assessment.
What should I bring to my first visit to a liver doctor?
All blood reports in date order, imaging CDs (not just reports), any FibroScan printout, a written list of every medicine including ayurvedic and herbal products, an honest alcohol history, and your family history of liver disease, hepatitis B or diabetes.
Which are the most important questions to ask a liver specialist?
What is the cause of my liver disease, what stage is it (fibrosis or FibroScan reading), is it reversible, which medicines should I avoid, and — if I have cirrhosis — do I need an endoscopy for varices and six-monthly liver cancer screening.
Can I take painkillers if I have cirrhosis?
Anti-inflammatory painkillers (NSAIDs) are advised against in cirrhosis with ascites because they can trigger kidney injury and fluid retention. Ask your hepatologist which painkiller is safe for you and at what limit; do not rely on an article for doses.
When should someone with cirrhosis be referred for liver transplant evaluation?
After any decompensation — ascites, variceal bleeding, hepatic encephalopathy — or when the MELD score is rising. Evaluation is not a commitment to surgery; it ensures you are not referred too late.
Book a consultation with Dr Chetan Kalal at Gleneagles Hospital, Mumbai — call +91 83294 76669 or use the appointment form on this site. International and NRI patients may request a teleconsultation.
References
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–460. PMID 29653741. doi:10.1016/j.jhep.2018.03.024
- Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922–1965. PMID 37199193. doi:10.1097/HEP.0000000000000466
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol. 2025;82(2):315–374. PMID 39690085. doi:10.1016/j.jhep.2024.08.028
- de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–974. PMID 35120736. doi:10.1016/j.jhep.2021.12.022
