Liver Doctor & Hepatology Care in Fort Smith, Arkansas

Liver care here answers one question: what is actually happening inside your liver, and what can be done about it. Dr. Herraka stages it with a FibroScan in the office rather than sending you elsewhere for a biopsy, and treats fatty liver, hepatitis, elevated enzymes and cirrhosis in Fort Smith.

Our liver program

Liver care here is built around one question: what is really happening inside your liver, and what can be done about it? Digestive & Liver Center of Arkansas is a physician-owned Fort Smith gastroenterology practice that has cared for the River Valley since 2016, and the liver is a large part of what we do. Your care is led by Ihab Herraka, MD. He is board-certified in gastroenterology, internal medicine, and obesity medicine, and he is a diplomate of the American Board of Obesity Medicine. He completed his internal medicine residency and gastroenterology fellowship at the University of Florida and Shands in Gainesville, and he has been in practice since 2012. He is a member of the American Association for the Study of Liver Diseases (AASLD), the American College of Gastroenterology (ACG), and the American Society for Gastrointestinal Endoscopy (ASGE). He sees patients in English and Arabic. That mix of training matters more than it sounds. A fatty liver is almost never a liver problem by itself. It is usually driven by weight, insulin resistance, blood sugar, and cholesterol. Here, one physician treats the liver and the metabolism behind it, instead of sending you to two different specialists who never talk to each other. Visits are at 3416 Old Greenwood Rd, Fort Smith, AR 72903, Monday through Friday, 8:00 to 5:00. FibroScan testing is done on site, so most patients get real answers the same day. For most plans you do not need a referral. Patients come to us from Fort Smith, Van Buren, Greenwood, Alma, Barling, and Charleston, and from Poteau and Sallisaw in eastern Oklahoma.

Who should have their liver checked?

You should be evaluated if something has already pointed at your liver, or if you carry the risk factors that make liver disease likely. Most liver disease is silent in its early years, so waiting until you feel sick is not a plan. The most common reasons patients are seen in the liver program:

• Abnormal liver enzymes (a high ALT or AST) on routine bloodwork
• "Fatty liver" or "hepatic steatosis" mentioned on an ultrasound, CT, or MRI that was done for some other reason
• Type 2 diabetes, prediabetes, or insulin resistance
• Obesity or extra weight around the middle, or a diagnosis of metabolic syndrome
• High triglycerides, low HDL cholesterol, or high blood pressure
• Hepatitis B or hepatitis C, current or in the past
• A FIB-4 score or a low platelet count your primary care provider flagged
• A family history of cirrhosis or liver cancer When symptoms do appear, they are usually vague: tiredness that does not lift, or a dull ache under the right ribs. Many people feel completely normal. A few symptoms are different and should not wait. Yellow eyes or skin, dark urine, a swollen belly or legs, new confusion, vomiting blood, or black tarry stools need urgent medical care. Call 911 or go to the nearest emergency room if you think it is an emergency.

Conditions and services

Liver disease is a focus here, not a sideline of a general practice. These are the areas we work in every day:

• Fatty liver disease (MASLD): fat stored in the liver, formerly called NAFLD. This is the most common liver condition we treat, and the most treatable.
• MASH and liver fibrosis: fatty liver that has moved on to inflammation, liver-cell injury, and scarring. This is the stage where treatment matters most, and where an FDA-approved medication now exists for selected patients.
• Elevated liver enzymes: finding out why your ALT or AST is abnormal, ruling out viral, autoimmune, alcohol-related, and medication causes, and deciding what comes next.
• FibroScan liver testing: a painless, in-office scan that measures both liver fat and liver stiffness (scarring) in about 10 minutes.
• Hepatitis B and hepatitis C: testing, staging and treatment, including the newer short-course cures for hepatitis C and long-term management of hepatitis B.
• Cirrhosis: advanced scarring: what compensated and decompensated mean, what monitoring involves, and what can still be changed.
• Alcohol-related liver disease: the whole spectrum, without judgement, and what improves when alcohol stops.
• Rezdiffra (resmetirom): the first FDA-approved medication for MASH, who is eligible, and how eligibility is established.
• Medical weight loss: physician-led weight and metabolic care, including GLP-1 medicines such as semaglutide and tirzepatide when they are appropriate for you. We also evaluate and manage autoimmune and other less common liver conditions. When advanced disease such as decompensated cirrhosis calls for transplant evaluation, we refer to the liver transplant program at UAMS in Little Rock, the only transplant program in Arkansas, and continue to manage your liver care alongside that team rather than stepping away. Because liver care sits inside a full gastroenterology practice, anything else your digestive health needs is handled by the same team in the same building, including colonoscopy and colon cancer screening. For adults at average risk, that screening now starts at age 45.

Why FibroScan changes the conversation

The question that decides your future is not "is there fat in my liver?" It is "is there scarring?" FibroScan answers both in one visit, without a needle. A FibroScan is a special ultrasound, called transient elastography. You lie on your back, we place a little gel on your right side, and a probe sends gentle pulses through the liver. It measures how stiff your liver is, which reflects scarring (fibrosis), and how much fat it holds. It takes about 10 minutes, there is no sedation, and you drive yourself home or go straight back to work. We pair that scan with a blood-based score called FIB-4 and with your lab trends. Together they let us stage fibrosis on the standard F0 to F4 scale, where F0 means no scarring and F4 means cirrhosis. Knowing your number is what turns "you have a fatty liver" into an actual plan. A full liver workup usually starts with blood tests (liver enzymes, a metabolic panel, and a viral hepatitis screen), moves to imaging such as ultrasound if it has not already been done, and adds FibroScan to stage fibrosis. For years the only way to get a fibrosis answer was a liver biopsy, and for most patients that is no longer necessary. Biopsy is still used when the noninvasive tests disagree, when another liver disease needs to be ruled out, or when the diagnosis stays unclear after the usual workup.

Weight loss is liver treatment, not a side project

For most people with fatty liver, treating weight and blood sugar is the liver treatment. There is no way around it, and there is no supplement that replaces it. The research is consistent: losing a modest amount of body weight, in the range of 5 to 10 percent, often lowers liver fat and can reduce inflammation. Greater and steadier weight loss gives the best chance of improving scarring. That is why obesity medicine is part of this liver program rather than a referral somewhere else. Dr. Herraka's weight loss program is medical care, not a diet plan. It starts with labs, looks at thyroid, blood sugar, and cholesterol, and uses prescription medication only when it is right for you. Weight comes off gradually on purpose, because very rapid weight loss can be hard on the liver. We set out how the two work together on fatty liver and weight loss.

What to expect at your first visit

Your first appointment is a full evaluation, not a five-minute look at one lab value. Plan on being with us for about an hour.

• Before you come: bring recent bloodwork and liver enzyme results, any ultrasound, CT, or MRI reports, a current list of your medications and supplements, your insurance card, and a photo ID.
• The history: we go through your medical history, weight history, alcohol use, medications, and family history, because several conditions can look identical on a lab report.
• The testing: we order or review a focused set of labs (ALT and AST, a metabolic panel, lipids, and HbA1c or blood sugar), rule out viral and autoimmune causes, and perform your FibroScan.
• The explanation: you leave knowing your stage, in plain language, and what it means for your risk over the next several years.
• The plan: nutrition and activity targets built around your real life, treatment of the metabolic drivers, medication when it is clinically indicated, and a date to recheck.

What results look like

Most patients who follow their plan see their liver enzymes start to move in the right direction within a few months, and see measurable change on repeat testing in six to twelve months. Liver tissue responds slowly, so we measure progress in seasons, not weeks. We recheck labs periodically and repeat the FibroScan on a schedule that fits your stage, usually about a year apart. If your numbers improve, we say so. If they do not, we change the plan rather than repeating it. No physician can promise a specific result, and any clinic that does should worry you.

Cost & insurance

Most liver visits and diagnostic testing, including FibroScan, are covered by major insurance plans in Arkansas and Oklahoma when they are medically indicated. Coverage for weight-loss medications is the part that varies most from policy to policy. We accept most major plans, including Medicare and both Arkansas and Oklahoma Medicaid, and the full list is on our insurance page. Self-pay pricing is available for elective services. Our team verifies your benefits before your visit so you know what to expect. If your plan requires a referral or prior authorization, we help you coordinate it. Bring your insurance card and photo ID to every appointment, and call us at (479) 242-2888 with any billing question, and we would rather answer it up front than surprise you later.

Talk to a liver specialist in Fort Smith

If a lab result, an ultrasound, or a family history has your liver on your mind, the next step is a clear answer rather than more worrying. Call (479) 242-2888 to reach Digestive & Liver Center of Arkansas, or come see us at 3416 Old Greenwood Rd, Fort Smith, AR 72903, Monday through Friday, 8:00 to 5:00. Most patients are seen promptly, and for most plans no referral is needed.