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Liver Health

  • What does my liver do?

    The liver is the largest internal organ in the body. It performs a myriad of functions, including processing everything that we eat and drink, filtering out harmful substances from the blood, regulating metabolism, synthesising protein, storing vitamins and iron and producing bile. A breakdown or disruption in any of these processes caused by liver diseases may lead to severe complications, liver failure and even death if liver diseases advance to the end stage.

    The following are some of the more common diseases that affect the liver:

  • What are Hepatitis A, B, C?

    Hepatitis refers to the inflammation of the liver. It can be caused by viral infections, chemicals, drug abuse, some medications and immune disorders. There are various forms of viral hepatitis including hepatitis A, B and C.

    What are the symptoms of hepatitis?

    Some hepatitis patients are asymptomatic, that is, they may show little or no symptoms. However, the general symptoms of hepatitis may include any of the following:

    • Abdominal pain or discomfort
    • Dark urine
    • Decreased appetite
    • Fever
    • Jaundice (yellowish skin and eyes)
    • Lethargy
    • Nausea and giddiness
    • Oedema
    • Painful joints
    • Pale colour stools

    Hepatitis can lead to:

    • Liver cancer
    • Liver cirrhosis
    • Liver failure
  • Hepatitis A

    What is hepatitis A?

    Hepatitis A virus infection causes acute inflammation of the liver.

    How is hepatitis A transmitted?

    Hepatitis A virus is transmitted through:

    • Blood contact, drug use and sexual contact with infected persons
    • Consuming shellfish from water contaminated with sewage
    • Direct contact with food, drinks or objects contaminated with the faeces of an infected individual
    • The ‘faecal-oral’ route where infected faecal particles from a person or animal are consumed by another person. This phenomenon is more common in areas of poor hygiene and overcrowding

    How is hepatitis A treated?

    There is no specific treatment for hepatitis A but there are measures that can help to improve the condition:

    • Avoid alcohol
    • Plenty of bed rest
    • Increase fluid intake
    • Practise good personal hygiene to prevent faecal-oral transmission
    • Take prescribed medication if symptoms worsen
  • Hepatitis B

    What is hepatitis B?

    Hepatitis B is the most common cause of liver infection. The majority of infected individuals recover from acute hepatitis B infection and become immune to it. However some people can develop a long-term hepatitis B infection, which leads to serious complications including chronic hepatitis, liver cirrhosis, liver failure and liver cancer. Hepatitis B is endemic in Singapore and around 4% of the population are hepatitis B carriers.

    How is hepatitis B transmitted?

    Hepatitis B can be transmitted through:

    • Infected expecting mothers can transmit the infection to their newborn
    • Activities that involve contaminated blood entering the bloodstream of a susceptible individual
    • Sharing contaminated injections among drug users
    • Unsafe sexual contact with an infected person

    How is hepatitis B treated?

    Treatment of hepatitis B depends on the symptoms and stage of your disease and include:

    • Anti-viral medication to stop the virus from replicating
    • Medication to relieve symptoms
  • Hepatitis C

    What is hepatitis C?

    Hepatitis C infection is responsible for the development of chronic liver disease worldwide. The virus cannot be eliminated in most infected people and consequently causes ongoing damage to the liver over a long period of time. Similar to hepatitis B, hepatitis C can lead to chronic hepatitis, cirrhosis, liver failure and liver cancer.

    How is hepatitis C transmitted?

    The hepatitis C virus is mainly found in the blood and is transmitted when the blood of an infected person enters the bloodstream of a susceptible person. This can happen in situations such as when contaminated needles are shared

    How is hepatitis C treated?

    The treatment of hepatitis C is aimed at delaying its complications. It includes:

    • Anti-viral medication to stop the virus from replicating
    • Abstinence from alcohol (to lessen the extent of liver damage)
    • Regular screening for liver cancer for hepatitis C carriers, especially those who have liver cirrhosis
  • What is Fatty Liver Disease?

    When the body creates too much fat or cannot metabolise fat fast enough, the excess fat is stored in liver cells where it can accumulate and result in fatty liver disease. The liver normally contains some fat, but if fat composes as much as 5% to 10% of the liver’s weight, it may be a sign of fatty liver disease. This condition usually has no symptoms and is reversible.

    There are 2 main types of fatty liver disease:

    • Alcoholic fatty liver disease
    • Non-alcoholic fatty liver disease

    How is fatty liver disease treated?

    There is no specific treatment available for fatty liver disease but it can be managed by treatment and lifestyle changes including the following:

    • Avoid alcohol
    • Manage diabetes condition
    • Lose weight
    • Maintain a balanced and healthy diet
    • Exercise regularly and stay fit
    • Cut down on foods high in carbohydrates such as bread, rice and potatoes
    • Cut down on sugar and sugary drinks
  • What is Alcoholic Fatty Liver Disease?

    A high intake of alcohol can damage the liver and disrupt its ability to break down fats. This can result in alcoholic fatty liver disease.

    What causes alcoholic fatty liver disease?

    • Heavy drinking (prolonged or short-term)
    • Hepatitis C
    • Too much iron in the body
    • Obesity
    • Hereditary genes that affect how the liver breaks down alcohol
  • What is Non-Alcoholic Fatty Liver Disease?

    When there is an accumulation of fat in the liver of people who drink little or no alcohol, it may be non-alcoholic fatty liver disease. This condition is actually fairly common and those afflicted usually present no sign or symptom. The fat can cause inflammation and scarring in the liver and may lead to more serious liver conditions.

    What causes non-alcoholic fatty liver disease?

    Those who are more prone to this condition tend to share the following traits:

    • Middle-aged
    • Obese
    • High cholesterol levels
    • Diabetic

    This condition can also be caused by:

    • Certain drugs or taking too many types of medications
    • Hepatitis infection
    • Inherited liver disease
    • Sudden weight loss
  • What is Liver Fibrosis?

    Every time the liver is injured, it will try to repair itself. This results in the formation of scar tissue on the liver. If the liver is continually injured, scar tissue will accumulate in the liver, replacing healthy liver cells.

    What causes liver fibrosis?

    Liver fibrosis can be caused by different liver diseases and conditions. The main causes include:

    • Chronic alcohol consumption
    • Hepatitis B and C infection

    Other causes include:

    • Autoimmune hepatitis, which is a liver disease caused by the body’s own immune system
    • Frequent exposure to environmental toxins and drugs
    • Non-alcoholic fatty liver disease, which is caused by fat accumulation in the liver
    • Poorly formed or blocked bile ducts, which cause bile to build up in the liver
    • Primary biliary cirrhosis, an autoimmune disease where the bile ducts are damaged, causing bile to build up in the liver
    • Schistosomiasis, which is a parasitic infection common in developing countries
    • Wilson’s disease caused by accumulation of copper in the liver

    How is liver fibrosis treated?

    Liver fibrosis can be slowed and even stopped by treating the disease that is damaging the liver, or with lifestyle changes:

    • Avoid alcohol
    • Treat infections promptly
    • Get vaccinated or treated for hepatitis A and B
    • Maintain a healthy, well-balanced, low sodium, low fat diet that includes ample amounts of fruits and vegetables
    • Avoid raw seafood due to the risk of infection
    • Regular exercise and adequate rest
  • What is Liver Cirrhosis?

    Liver fibrosis can progress to liver cirrhosis, which is the scarring of the liver due to long-term damage to the liver. The damage is irreversible – the more scar tissue there is, the harder it is for the liver to function.

    Liver cirrhosis can lead to:

    • Brain confusion due to high levels of toxins in the blood and brain
    • High blood pressure in the liver
    • Increased risk of liver cancer

    What are the symptoms of liver cirrhosis?

    When significant liver damage has occurred, patients may experience the following symptoms:

    • Black stool
    • Changes in personality and confusion in severe cases
    • Fatigue and lethargy
    • Fluid accumulation in the abdomen
    • Itchy skin
    • Jaundice (yellowish eyes and skin)
    • Loss of weight and loss of appetite
    • Nausea
    • Red spider-looking spots on your chest and back
    • Sleeping difficulties
    • Swelling of the legs
    • Vomiting blood

    How is liver cirrhosis treated?

    The liver damage caused by cirrhosis cannot be reversed. However, there are treatment options available to prevent or delay the onset of further damage and complications. The treatment depends on the cause of the cirrhosis:

    • Cirrhosis caused by chronic alcohol abuse is managed by avoiding alcohol consumption
    • Cirrhosis caused by Wilson’s Disease can be treated with medications that expel the accumulated copper in the liver
    • Hepatitis-related cirrhosis is treated with medication, depending on the type of hepatitis infection
    • Liver transplant may be necessary for end-stage liver cirrhosis patients
  • What is Liver Cancer?

    Liver cancer is an abnormal growth of tissue in the liver. Primary liver cancer occurs when the tumour grows from the cells of the liver. Secondary (metastatic) liver cancer occurs when the main cancer spreads from elsewhere in the body to the liver. Liver cancer is more common in Asia than in Western countries.

    The liver is made up of many different types of cells. Primary liver cancer is named after the cells from which the cancer developed.

    • The main cells in the liver are called hepatocytes. A cancer growing from these cells is called hepatocellular carcinoma or hepatoma.
    • The cells that line the bile ducts (tubes) are called cholangiocytes. A tumour in these cells is called a cholangiocarcinoma or bile duct cancer.

    What causes liver cancer?

    The 3 common causes of primary liver cancer are:

    • Chronic hepatitis B infection
    • Chronic hepatitis C infection
    • Liver disease caused by excessive alcohol consumption

    Other causes include inherited liver conditions, cirrhosis (scarring of the liver), or a poison called aflatoxin found in mouldy peanuts, wheat, soya and grain.

    How is liver cancer treated?

    The treatment for liver cancer depends on the size of the tumour and how much it has spread. Treatment methods include:

    • Chemotherapy to kill the cancer cells. This can be given as injections into the vein or may be injected directly into the liver cancer in a process called chemoembolization. A gel may be injected at the same time to block the blood flow to the cancer.
    • Radiation therapy (high-energy X-ray) to kill the cancer cells or stop them from spreading.
    • Liver resection, where the affected part of the liver is removed surgically. This can cure early stage liver cancer if the rest of the liver is healthy.
    • Tumour ablation, where liver cancer cells are destroyed by directly introducing high heat or or concentrated ethanol to the tumour.
    • Liver transplant, which involves the removal of the entire liver and replacement with a healthy donated liver. This can only be done when a donated liver is available, but a successful liver transplant tends to have a very good prognosis.

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