Liver Disease
Fatty Liver Disease (Steatosis)
What is Fatty Liver Disease?
Fatty liver disease, or hepatic steatosis, is a common condition characterised by the buildup of fat in your liver. While a healthy liver does contain a small amount of fat, it becomes an issue when the fat’s weight reaches 5% to 10% of your liver’s weight. Too much fat can cause liver inflammation (hepatitis), which can damage your liver and create scarring (liver fibrosis). In severe untreated cases, the scarring will eventually replace healthy tissue (hepatic cirrhosis) and lead to liver failure or liver cancer.
There are two forms of fatty liver disease:
– Alcoholic liver disease – Alcoholic fatty liver is the accumulation of fat in the liver as a result of heavy alcoholic consumption.
– Nonalcoholic fatty liver disease (NAFLD) – NAFLD occurs in people who do not consume large amounts of alcohol and affects one in three adults. While exact cause remains unknown, several factors such as diabetes and obesity can increase risk of getting NAFLD.
Fatty liver disease often shows no symptoms until the disease progresses to the point of liver cirrhosis. Signs and symptoms include:
– Abdominal pain
– Nausea
– Loss of appetite
– Unexplained weight loss
– Swollen abdomen or legs (oedema)
– Yellowish whites of the eyes and yellowish skin (jaundice)
– Extreme tiredness or mental confusion
Diagnosis and Management
As fatty liver disease often shows no signs or symptoms, it is often the doctor that spots it. In a blood test for other conditions, higher levels of enzymes (elevated liver enzymes) may be a sign of liver injury. To diagnose fatty liver disease, Dr Ong may recommend:
– Ultrasound or computed tomography (CT scan)
– Liver biopsy (tissue sample)
– Fibroscan(?)
As there is no specific medication for fatty liver disease, lifestyle changes would be recommended to improve factors that contribute to the condition. Measures include:
– Avoiding alcohol
– Losing weight
– Exercise
– Managing diabetes, cholesterol, and triglycerides (fat in blood)
Hepatitis
Hepatitis is the inflammation of the liver, which is a vital organ that processes nutrients, fights infections, and filters the blood.
When the liver is inflamed or injured, its function may be affected. There are various causes of hepatitis, including viral hepatitis
A-E, alcoholic hepatitis, autoimmune hepatitis, and steatohepatitis (which is an advanced form of fatty liver disease).
Diagnosis
Based on your symptoms, physical examination, and medical history, Dr Ong will recommend tests to rule out other conditions
and diagnose the type of hepatitis. The type of hepatitis determines the type of management and treatment you require. The
following tests may be conducted:
– Liver function tests (blood test)
– Liver tissue sample (biopsy)
– Abdominal ultrasound
Viral Hepatitis
Hepatitis A
Hepatitis A is the infection of the liver by the hepatitis A virus (HAV). Hepatitis A is an acute short-term disease and is spread
when faecal particles from an infected person make their way into a healthy person’s mouth (faecal-oral transmission). This is a
common cause of hepatitis in developing countries with poor sanitation in food preparation. Outbreaks are frequently
associated with shellfish consumption. Hepatitis A is very contagious and can spread from close contact with an infected
person, caring for someone who is ill, some types of sexual contact, or drug use. HAV vaccines are available.
While not everyone with hepatitis A have symptoms, those who do usually have their symptoms appearing 2 to 7 weeks after
infection. Signs and symptoms include:
– Fever
– Headache
– Reduced appetite
– Muscle pain
– Jaundice
– Itching
– Nausea and vomiting
It often does not require treatment with 99% of cases ending with recovery.
If symptoms cause great discomfort, bed rest or relief medication may be necessary.
Hepatitis B
Hepatitis B is the infection of the liver by the hepatitis B virus (HBV). Hepatitis B is often an ongoing, long-term chronic
condition and is a leading cause of death worldwide. It may also be a short-term (acute) condition. It is transmitted sexually,
through serum (blood transfusions, transplants, intravenous drug use), and from mother to child in pregnancy. The high death
rate in HBV may be attributed to the fact that many with chronic HBV infection do not show any symptoms as their liver gets
damaged. If symptoms do appear however, they will present similarly to those with acute HBV infection
Signs and symptoms include:
– Fever
– Fatigue
– Reduced appetite
– Nausea and vomiting
– Abdominal pain
– Dark urine
– Clay-coloured stool
– Joint pain
– Yellowish whites of the eyes and yellowish skin (jaundice)
There is no specific treatment for acute hepatitis B and will be handled on a case-by-case basis by Dr Ong. However, if you
have chronic hepatitis B, you will require antiviral medication. This treatment may be costly as it needs to be continued for
several months or years. Treatment of chronic hepatitis B also requires regular medical checkups to see if the treatment is
working.
Hepatitis C
Hepatitis C is the infection of the liver by the hepatitis C virus (HCV). HCV is one of the most common blood-borne viral
infections in the United States and is an ongoing, long-term chronic condition. Most people become infected with HCV through
blood by sharing needles in intravenous drug use or other equipment used to prepare or inject drugs. It may also be contracted
through sexual contact. HCV is the most common reason for liver transplant. Most people are unaware of their infection.
Many newly infected people with HCV do not develop symptoms and are unaware that they are infected. For those with acute
hepatitis C who do develop symptoms however have the following signs and symptoms:
– Yellowish whites of the eyes and yellowish skin (jaundice)
– Reduced appetite
– Abdominal pain
– Dark urine
– Clay-coloured stool
– Joint pain
– Fatigue
– Nausea and vomiting
Most people with long-term (chronic) hepatitis C do not have any symptoms or only have general symptoms such as chronic
depression and fatigue. Many of them develop chronic liver disease which can range from mild to severe, including cirrhosis
(liver scarring) and liver cancer. Most people with chronic HCV are not aware of their diagnosis until they are screened for a
blood donation or from an abnormal blood test found during a routine health checkup.
The treatment of hepatitis C usually requires antiviral medications. This treatment may be costly as it needs to be continued for
several months. Treatment of chronic hepatitis C also requires regular medical checkups to see if the treatment is working.
People who develop cirrhosis or severe liver disease due to HCV may need a liver transplant.
Hepatitis D
Hepatitis D is the infection of the liver by the hepatitis D virus (HDV). Similar to other strains, HDV causes liver inflammation but
a person cannot contract HDV without a current hepatitis B infection. Globally, HDV affects about 5% of people with long-term
(chronic) hepatitis B. HDV is considered the most severe form of hepatitis and can lead to liver cancer or liver failure over time.
HDV may be acquired together with HBV sexually, through serum (blood transfusions, transplants, intravenous drug use). HDV
may also be acquired AFTER a prior HBV infection through sexual contact, through serum (blood transfusions, transplants,
intravenous drug use), and through exchange of bodily fluids such as saliva.
Signs and symptoms of HDV include:
– Yellowish whites of the eyes and yellowish skin (jaundice)
– Reduced appetite
– Abdominal pain
– Dark urine
– Clay-coloured stool
– Joint pain
– Fatigue
– Nausea and vomiting
Hepatitis D is usually treated with pegylated interferon alpha but it may have severe side effects and is therefore not
recommended for people with severe liver damage, cirrhosis, psychiatric conditions, or autoimmune diseases.
Hepatitis E
Hepatitis E is the infection of the liver by the hepatitis E virus (HEV). Hepatitis E is uncommon and is mainly found in areas with
poor sanitation, typically resulting from ingesting faecal matter that contaminates a water supply. Hepatitis E is usually
short-term (acute) but can be especially dangerous in pregnant women.
While many are asymptomatic, those who do show signs and symptoms may have:
– Yellowish whites of the eyes and yellowish skin (jaundice)
– Reduced appetite
– Abdominal pain
– Dark urine
– Clay-coloured stool
– Joint pain
– Fatigue
– Nausea and vomiting
There is no specific medical therapy for hepatitis E because the infection often resolves on its own. As such, people with
hepatitis E infections are advised to get adequate rest, drink fluids, eat well, and avoid alcohol. Pregnant women with HEV
however require close monitoring and care.
Alcoholic Hepatitis
Alcoholic hepatitis is the inflammation of the liver caused by drinking alcohol. While this mostly occurs in people who drink
heavily over many years, this relationship is complex with some heavy drinkers never developing alcoholic hepatitis and other
moderate drinkers developing this alcoholic hepatitis. If you have contracted viral hepatitis and drink heavily, you are more likely
to develop liver scarring (cirrhosis).
Signs and symptoms include:
– Yellowish whites of the eyes and yellowish skin (jaundice)
– Reduced appetite
– Abdominal pain
– Dark urine
– Clay-coloured stool
– Joint pain
– Fatigue
– Nausea and vomiting
– Low grade fever
– Malnutrition
– Fluid accumulation in your abdomen (ascites)
Treatment of alcoholic hepatitis involves quitting drinking and therapies to relieve the signs and symptoms of liver damage. This
may involve medication, counselling, Alcoholics Anonymous, or an outpatient/residential treatment program.
For those with severe alcoholic hepatitis and cirrhosis, the risk of death is high without a liver transplant. However, those with
alcoholic hepatitis may not be suitable candidates for a liver transplant due to the risk that they will return to harmful drinking
after the transplant.
Alcoholic Hepatitis
In some cases, the immune system may mistake the liver as harmful to the body and attacks it. This is known as autoimmune
hepatitis and causes an ongoing inflammation that can range from mild to severe, often worsening liver function. Autoimmune
hepatitis is three times more common in women than in men.
Signs and symptoms include:
– Yellowish whites of the eyes and yellowish skin (jaundice)
– Reduced appetite
– Abdominal pain
– Dark urine
– Clay-coloured stool
– Joint pain
– Fatigue
– Nausea and vomiting
– Skin conditions such as rash, psoriasis, vitiligo, or acne
Treatment often involves the use of corticosteroids which are effective in about 80% of people with autoimmune hepatitis. Other
drugs that suppress the immune system may also be part of the treatment programs, with or without steroids.
Other symptoms
Vomiting, Nausea,
Abdominal Pains
Bloatedness
Stomach Pain
Blood in stool
Diarrhoea, Constipation
and Intestinal Pain