Liver disease is usually silent without displaying any symptom until a significant loss of liver function has occurred. Whatever the cause of liver disease may be, the usual sequence is persistent inflammation of the liver leading to fibrosis (the formation of scar which results in the hardening of tissues), and ending with liver cirrhosis (a damaged and scarred liver) and liver failure. Very occasionally, the liver may fail acutely within days or weeks if the inflammation is very severe.
Patients are usually asymptomatic or have very non-specific symptoms of fatigue and occasionally complain of pruritus (itch). As the liver disease progresses with further loss of liver function, the patient may experience edema (swelling), jaundice (yellowing of skin) and confusion due to hepatic encephalopathy. The patient may occasionally suffer from complication of cirrhosis such as bleeding from varicose veins in the esophagus or the stomach, ascites (fluid in the abdomen) or liver cancer.
The commonest cause of liver disease in the South East Asia is viral hepatitis which includes hepatitis A, B, C and E. Hepatitis B and C are the viruses that can lead to chronic liver disease.
Increasingly, fatty liver disease is fast growing into a common liver disease as more are becoming overweight or obese. Fatty liver disease describes a range of conditions caused by a build-up of fat within liver cells. Majority with fatty liver disease do not develop serious liver problems however in a small percentage the build-up of fat in the liver can lead to serious liver problems. Fatty liver is also associated with diabetes and hyperlipidaemia and as such patients with fatty liver disease have an increased risk of developing cardiovascular problems such as heart attack and stroke due to the common risk factors.
Other causes of liver disease include alcohol, drug-induced liver injury (from prescribed medications or Traditional Chinese Medicine), auto-immune or genetically acquired liver diseases.
As liver disease is usually silent most are diagnosed incidentally during health screening. Hence it is advisable to screen at-risk individuals for viral hepatitis particularly (those with a family history), alcoholic liver disease (drinking > 3 alcoholic drinks/day), fatty liver, etc. The screening involves a simple blood test looking at the liver function, lipid profile, hepatitis B and C serology; if the liver function test results are abnormal, an ultrasound scan should be performed. In the past, liver biopsies (removal of a small sample of liver tissues) are required to assess the amount of scarring in the liver or to confirm cirrhosis. Today, technology has advanced such that we can assess this non-invasively without the risk of complications with a special machine known as FibroScan® or MR elastogram.
Once an underlying liver disease is identified the aims for regular reviews are to (i) to prevent the progression of the underlying liver disease, and (ii) screen and manage complications associated with liver failure and liver cirrhosis.
Overall the main treatment for fatty liver is usually gradual weight loss, regular exercise and management of the diabetes and hyperlipidaemia. This not only helps with fatty liver disease but will help reduce the risk of developing cardiovascular problems. Adequate management of an underlying liver disease by removing the cause of the liver injury (e.g. alcohol) or by treating the underlying disease (e.g. hepatitis B or C, auto-immune liver disease) may prevent the progression of the liver disease and the existing damage may even recover over time. In patients with significant liver dysfunction the liver may recover with adequate function to keep the patient healthy without a need for liver transplantation.
The take home message is that liver disease is silent and screening involves a simple blood test. If an underlying liver disease is discovered early, future complications of cirrhosis and liver failure are usually preventable.
Patients are usually asymptomatic or have very non-specific symptoms of fatigue and occasionally complain of pruritus (itch). As the liver disease progresses with further loss of liver function, the patient may experience edema (swelling), jaundice (yellowing of skin) and confusion due to hepatic encephalopathy. The patient may occasionally suffer from complication of cirrhosis such as bleeding from varicose veins in the esophagus or the stomach, ascites (fluid in the abdomen) or liver cancer.
The commonest cause of liver disease in the South East Asia is viral hepatitis which includes hepatitis A, B, C and E. Hepatitis B and C are the viruses that can lead to chronic liver disease.
Increasingly, fatty liver disease is fast growing into a common liver disease as more are becoming overweight or obese. Fatty liver disease describes a range of conditions caused by a build-up of fat within liver cells. Majority with fatty liver disease do not develop serious liver problems however in a small percentage the build-up of fat in the liver can lead to serious liver problems. Fatty liver is also associated with diabetes and hyperlipidaemia and as such patients with fatty liver disease have an increased risk of developing cardiovascular problems such as heart attack and stroke due to the common risk factors.
Other causes of liver disease include alcohol, drug-induced liver injury (from prescribed medications or Traditional Chinese Medicine), auto-immune or genetically acquired liver diseases.
As liver disease is usually silent most are diagnosed incidentally during health screening. Hence it is advisable to screen at-risk individuals for viral hepatitis particularly (those with a family history), alcoholic liver disease (drinking > 3 alcoholic drinks/day), fatty liver, etc. The screening involves a simple blood test looking at the liver function, lipid profile, hepatitis B and C serology; if the liver function test results are abnormal, an ultrasound scan should be performed. In the past, liver biopsies (removal of a small sample of liver tissues) are required to assess the amount of scarring in the liver or to confirm cirrhosis. Today, technology has advanced such that we can assess this non-invasively without the risk of complications with a special machine known as FibroScan® or MR elastogram.
Once an underlying liver disease is identified the aims for regular reviews are to (i) to prevent the progression of the underlying liver disease, and (ii) screen and manage complications associated with liver failure and liver cirrhosis.
Overall the main treatment for fatty liver is usually gradual weight loss, regular exercise and management of the diabetes and hyperlipidaemia. This not only helps with fatty liver disease but will help reduce the risk of developing cardiovascular problems. Adequate management of an underlying liver disease by removing the cause of the liver injury (e.g. alcohol) or by treating the underlying disease (e.g. hepatitis B or C, auto-immune liver disease) may prevent the progression of the liver disease and the existing damage may even recover over time. In patients with significant liver dysfunction the liver may recover with adequate function to keep the patient healthy without a need for liver transplantation.
The take home message is that liver disease is silent and screening involves a simple blood test. If an underlying liver disease is discovered early, future complications of cirrhosis and liver failure are usually preventable.