Hepatology & Liver Care

Hepatology — the medical specialty focused on diseases of the liver — is a major focus of Dr. Ramani's practice. Trained at UTHealth Houston as Chief Fellow, with peer-reviewed research on hepatocellular carcinoma mortality, cirrhosis, and liver disease epidemiology, his clinical work spans the full spectrum of acute and chronic liver disease.

Conditions Treated

Fatty Liver Disease (MASLD/MASH)

The most common chronic liver disease in the U.S. Includes risk stratification, FibroScan, lifestyle therapy, GLP-1 considerations, and emerging MASH pharmacotherapy. Detailed page: Fatty Liver Disease.

Hepatitis B and C

Hepatitis C is now curable in >95% of patients with 8–12 weeks of direct-acting antiviral therapy. Hepatitis B is treatable with long-term suppressive antivirals. The CDC recommends universal one-time hepatitis C screening for all adults.

Cirrhosis

Comprehensive cirrhosis care including:

• HCC surveillance with abdominal ultrasound (and AFP) every 6 months
• Variceal screening via upper endoscopy
• Management of ascites, hepatic encephalopathy, and SBP
• Vaccinations and infection prophylaxis
• MELD-Na monitoring and transplant evaluation when appropriate

Hepatocellular Carcinoma (HCC)

Surveillance, multidisciplinary diagnosis, and coordinated care. Dr. Ramani's 2022 publication in Digestive Diseases and Sciences examined HCC-related mortality trends in the U.S. — making this a particular focus area.

Autoimmune Liver Disease

Autoimmune hepatitis, primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Management includes immunosuppressive therapy, ursodiol, and surveillance imaging.

Alcohol-Related Liver Disease

Comprehensive evaluation, severity scoring, and integrated care including medical management of alcohol use disorder. Early diagnosis significantly improves outcomes.

Genetic and Metabolic Liver Disease

Hereditary hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, and other inherited causes of liver disease.

Cholestatic and Biliary Disease

PBC, PSC, drug-induced cholestasis, and biliary stricture evaluation.

Diagnostic Tools

• FibroScan — non-invasive ultrasound-based fibrosis and steatosis assessment
• FIB-4 and APRI scores — lab-based fibrosis estimates
• Comprehensive viral, autoimmune, and metabolic labs
• MR Elastography (MRE) — gold-standard non-invasive fibrosis quantification
• Liver biopsy — when histology is required for diagnosis or staging
• Surveillance imaging — ultrasound, MRI, CT for HCC screening

When to See a Hepatologist

• Persistently elevated liver enzymes (ALT, AST, alkaline phosphatase)
• Fatty liver disease on imaging
• Newly diagnosed hepatitis C, hepatitis B, or autoimmune liver disease
• Cirrhosis or suspected advanced fibrosis
• Family history of liver disease, hereditary hemochromatosis, or Wilson's disease
• HCC surveillance
• Pre-transplant evaluation or post-transplant care coordination

Hepatology & Liver Disease: Common Questions