The Most Common Liver Diseases

Causes and Risk Factors for NAFLD

The exact cause of NAFLD is not fully understood, but it is strongly associated with metabolic dysfunction.

• Obesity

  : Excess body weight can cause fat to build up in the liver tissue.

• Insulin Resistance

  : When the body becomes less responsive to insulin (common in type 2 diabetes), it often results in higher fat storage within the liver.

• Hyperlipidaemia

  : High levels of fats in the bloodstream (hyperlipidaemia) can lead to fatty liver development.

Symptoms of NAFLD

NAFLD is often asymptomatic in its early stages. As the disease progresses, symptoms may include:

• Fatigue

• Discomfort in the upper right abdomen

• Unexplained weight loss

Diagnosis of NAFLD

Diagnosis of NAFLD typically involves the following tests:

• Blood Test

  : This test can detect high levels of liver enzymes in the blood (a sign of a fatty liver), as well as rule out other liver conditions such as viral hepatitis.

• Imaging Tests

  : Imaging studies like ultrasound or CT scan can reveal abnormalities in the liver.

• FibroScan

  : This specialised ultrasound examines the liver to determine the extent of fat tissue and scarring.

• Liver Biopsy

  : For advanced cases, doctors may extract and microscopically analyse tissue samples to assess the progression of liver disease.

Treatment for NAFLD

Treatment for NAFLD focuses on lifestyle modifications to reduce liver fat and improve overall health. These include:

• Dietary Changes

  : Adopt a balanced diet low in saturated fats and sugars.

• Regular Exercise

  : Engage in physical activities regularly to achieve and maintain a healthy weight.

• Medical Management

  : Prescribed medications can control underlying conditions like diabetes and hyperlipidaemia.

Transmission of Hepatitis B and C

While Hepatitis B and C are both blood-borne viruses, their modes of transmission differ slightly in terms of prevalence and risk.

• Hepatitis B

  : This highly infectious virus is transmitted through contact with infectious body fluids, such as blood, semen, and vaginal secretions. Common modes of transmission include unprotected sexual contact, sharing needles, or from an infected mother to child during childbirth.

• Hepatitis C

  : This virus is primarily spread through blood-to-blood contact. This includes sharing needles, receiving unscreened or contaminated blood transfusions, and exposure to unsterilised medical or tattooing equipment.

Symptoms of Hepatitis B and C

Many individuals with chronic hepatitis B or C may remain asymptomatic for years. When symptoms occur, they can include:

• Jaundice (yellowing of the skin and eyes)

• Fatigue

• Mild fever

• Nausea and vomiting

• Loss of appetite

• Abdominal pain or discomfort, especially around the liver area

• Pale or clay-coloured stools

• Dark urine

• Joint pain

Diagnosis of Hepatitis B and C

Diagnosis of Hepatitis B and C involves the following tests:

• Physical Examination

  : The doctor will palpate the abdominal area to check for liver enlargement or inspect the skin and eyes for signs of yellowing or jaundice.

• Blood Test

  : Through blood tests, the doctor can detect antibodies and viral markers, as well as determine whether the viral infection is acute or chronic.

• Liver Function Test

  : This test evaluates the levels of liver enzymes and proteins in the blood to assess liver health and detect possible damage.

Treatment for Hepatitis B and C

Depending on the symptoms and stages of the disease, treatments for Hepatitis B and C may include:

• Antiviral Medications

  : These medications are prescribed to suppress the virus and reduce liver damage.

• Regular Monitoring

  : This helps evaluate the effectiveness of the treatment and ensure that the virus is eliminated.

Causes of Liver Cirrhosis

Liver cirrhosis typically results from a variety of factors, such as:

• Chronic Alcohol Abuse

  : Long-term excessive alcohol consumption can lead to liver damage.

• Chronic Viral Hepatitis

  : Persistent infection with hepatitis B or C viruses may increase the risk of cirrhosis.

• NAFLD

  : This is a condition where excess fat builds up in the liver unrelated to alcohol use, leading to inflammation and scarring (fibrosis) over time, and eventually progressing to liver cirrhosis if left untreated.

Symptoms of Liver Cirrhosis

Symptoms of liver cirrhosis often go undetected until the disease becomes severe. These symptoms include:

• Fatigue

• Easy bruising or bleeding

• Swelling in the legs (oedema)

• Fluid accumulation in the abdomen (ascites)

• Jaundice

• Sudden weight loss

• Itchy skin

• Gynaecomastia or testicular atrophy in men

• Presence of spider-like spots on the chest and back (spider angiomas)

• Sleeping difficulties, drowsiness, or confusion

Diagnosis of Liver Cirrhosis

Liver cirrhosis is typically diagnosed using the following tests:

• Blood Tests

  : A series of blood tests is done to measure various liver enzymes, proteins, and other substances, assess liver function, and detect signs of liver damage.

• Imaging Studies

  : Ultrasound, CT scan, or MRI can reveal structural changes in the liver.

• Liver Biopsy

  : In some cases, a liver biopsy may be performed to confirm the diagnosis and assess the extent of scarring.

Treatment for Liver Cirrhosis

While liver damage from cirrhosis cannot be reversed, there are various medical interventions available to address the underlying causes and potentially slow or prevent additional damage and complications. These treatment approaches may include:

• Lifestyle Modifications

  : Incorporating a balanced diet low in salt and abstaining from alcohol can help promote liver health.

• Medication Management

  : The use of specific medications can alleviate symptoms associated with cirrhosis, such as fluid build-up, bleeding, or infection.

• Liver Transplantation

  : In advanced cases, liver transplantation may be considered, in which the diseased liver is replaced with a healthy donor liver.

Risk Factors for Liver Cancer

Liver cancer is a serious and often life-threatening disease that typically arises from chronic liver damage and other factors, including:

• NAFLD/NASH

  : These conditions can progress to cirrhosis and subsequently increase the risk of liver cancer.

• Family History

  : Genetic predispositions may increase the risk of an individual to liver malignancies.

• Hepatitis Infection

  : Chronic hepatitis B (HBV) and hepatitis C (HCV) are strongly linked to the development of liver cancer.

• Aflatoxin Exposure

  : Consumption of contaminated foods, such as improperly stored grains and nuts, can increase cancer risk of liver cancer.

• Lifestyle Factors

  : Excessive alcohol consumption, smoking, and obesity can further increase the risk of liver cancer.

Symptoms of Liver Cancer

Liver cancer may not cause symptoms in its early stages. However, common signs may start to appear as the disease progresses, including:

• Unexplained weight loss

• Persistent pain in the upper abdominal, back, or right shoulder blade

• Early satiety (feeling full quickly after a small meal)

• Jaundice

• Generalised fatigue and weakness

• Nausea and vomiting episodes

• Itching

• Loss of appetite

• Abdominal swelling from fluid buildup (ascites)

• Abnormal bruising and bleeding from the gut

• A hard abdominal mass on the right side, just below the rib cage

• White, chalky stool and dark urine

Diagnosis of Liver Cancer

Dr Kieron Lim employs a combination of imaging scans, blood tests, and biopsy (when necessary) to confirm the diagnosis.

• Blood Test

  : This test can assess liver function and detect the presence of tumour markers, such as alpha-fetoprotein (AFP).

• Imaging Scans

  : Imaging studies, such as ultrasound, CT scan, or MRI, can generate detailed images of the liver to locate the tumour and assess its size and location.

• Biopsy

  : If other tests are not conclusive of liver cancer, a biopsy may be performed to confirm the diagnosis and determine the cancer subtype.

Read More: Understanding Stage 4 Liver Cancer

Treatment for Liver Cancer

Liver cancer treatment depends on the stage of the disease, the patient’s overall health, liver function, and whether the cancer has spread. Treatment strategies can include:

• Surgical Resection

  : For localised tumours, surgical resection involves the removal of a cancerous portion of the liver.

• Liver Transplantation

  : Considered for eligible patients with early-stage disease and underlying cirrhosis, a liver transplant is used to remove the entire liver and replace it with a healthy liver from a donor.

• Ablation or Embolisation

  : These minimally invasive procedures help target the primary liver cancer cells and block the blood supply to the tumour.

• Systemic Therapy

  : This includes targeted therapy, where specific drugs are used to combat abnormalities within cancer cells. Immunotherapy can also be performed to help the body’s immune system recognise and attack cancer cells.

Liver diseases are increasingly common in Singapore due to a combination of lifestyle factors, viral infections, and chronic conditions. Awareness, early detection, and proactive management are vital to preventing serious complications like cirrhosis and liver cancer. Consulting with a liver specialist such as Dr Kieron Lim ensures access to a comprehensive diagnosis, evidence-based care, and long-term support tailored to individual needs.