Liver: Conditions and Treatment

The liver is a vital organ that is located on the upper right side of the abdomen. The liver is considered to be the largest internal organ of the body, and is also the only organ that has self-regenerating properties. This means that it can grow back to its full size, even if up to 70% of its original tissue is lost. Due to this self-regeneration, a living donor liver transplant can be carried out as the donor’s liver will regenerate.

What Does the Liver Do?

The liver plays many roles in the body, the main ones being:
Blood filtration and detoxification from the gut
Almost all the blood in the body, particularly those coming from the digestive tract, will pass through the liver. The liver filters the blood and breaks down toxic and harmful compounds like alcohol and certain drugs.

Converts food into substances needed for life and growth, and so helps to maintain proper sugar levels in the body.
Bile production
Bile is a greenish-yellow digestive fluid that converts fat into fatty acids to be absorbed by the small intestine, as well as excretes waste products from the liver.
Other functions of the liver include: promoting blood clot formation, storing and excreting vitamins and minerals as needed, regulating hormone and cholesterol levels, metabolizing proteins, fighting off infections and more.

Common Liver Diseases

Viral Hepatitis

Viral Hepatitis is a viral infection (mainly Hepatitis A, B, C and E) that causes the liver to become inflamed and unable to perform its normal functions properly. Depending on its type, it can be preventable through vaccination or by practicing preventative measures such as consuming uncontaminated food and liquids, not sharing needles and practicing safe sex. Patients who do contract Hepatitis B or C can be treated with antiviral medications with good results. Untreated viral Hepatitis B or C may lead to liver cirrhosis and liver cancer.

Fatty Liver Disease

Fatty liver disease, medically termed as hepatic steatosis, refer to an accumulation of fats in the liver, which can cause inflammation and scarring. It has two types: alcoholic fatty liver disease, which is caused by the excessive consumption of alcohol; and non-alcoholic fatty liver disease, which develops in individuals who drink little to no alcohol. Left untreated, both types can lead to cirrhosis, liver failure and liver cancer.

Liver Cirrhosis

Fibrosis refers to scarring in the liver that results from repetitive injury or chronic inflammation of the liver. If scarring is severe, in which the liver has already sustained significant damage and can no longer function properly, then it is called cirrhosis. Liver cirrhosis may lead to liver failure or liver cancer. Liver transplant surgery in Singapore is recommended for advanced to severe cirrhosis where liver failure has developed.

Autoimmune Diseases

Autoimmune diseases cause the body’s immune system to attack its own healthy tissues and organs, and sometimes that includes the liver.

Liver Cancer

Liver cancer, also known as Hepatocellular carcinoma, occurs when cancer cells develop and rapidly multiply in the liver, or may start elsewhere and then spread to the liver. The main risk factors for liver cancer are chronic Hepatitis B or C, alcohol excess and cirrhosis. Depending on the extent, liver cancer may be treated via liver cancer surgery to remove the parts of the liver with the tumour; or liver transplant surgery may be needed where there is also poor liver function.

Liver Failure

Liver failure is the last-stage complication of any liver disease, in which the liver cannot perform its functions fully and properly due to significant damage. It can be acute, occurring suddenly, or chronic, resulting from long-term liver disease or injury. Regardless, liver failure is a medical emergency that has life-threatening consequences if not treated immediately. Apart from medications, a liver transplant may be deemed necessary.

What Are the Symptoms of Liver Disease?

Symptoms vary from patient to patient, and will largely depend on the type and severity of the liver disease. However, conditions typically share similar symptoms, including:
  • Jaundice (yellowing of the skin)
  • Abdominal pain and swelling
  • Nausea and vomiting
  • Itchy skin
  • Swollen legs or ankles
  • Easy bruising
  • Itchy skin
  • Discolored urine
  • Pale stool

What Are the Treatments for Liver Disease?

Many liver diseases – particularly in the early stages – can be prevented or treated with diet and lifestyle changes, such as:
  • Reducing alcohol intake
  • Quitting smoking
  • Drinking plenty of fluids throughout the day
  • Eating a low-fat and low-sugar diet
  • Maintaining a healthy weight and active lifestyle
  • Hepatitis B and C treatment
Medications may also be prescribed to better manage the condition.
In advanced cases, liver surgery may be recommended. Depending on the condition and severity, a liver surgeon may perform:
  • Liver resection – This involves partial removal of the liver. This is commonly performed on patients with liver cancer, though it is not recommended for those with severe cirrhosis.
  • Liver transplant – This is a procedure in which a severely diseased liver is removed and replaced with a liver from a donor. Liver failure is a common reason for patients to get a transplant.
Dr Wong Jen San
Consultant Hepatobiliary & Pancreatic Surgeon
MBChB (UK), MMed (S’pore), Msc (S’pore), FRCS (Edin), FAMS

Upon graduating from the University of Leicester and completing his basic surgical training in the United Kingdom, Dr Wong went on to complete advanced training in Singapore before embarking on his HMDP clinical fellowship in Japan—specializing in living donor liver transplantation.

Prior to establishing his own practice, Dr Wong was previously a consultant with the Department of Hepatopancreatobiliary & Transplant Surgery at SGH, an adjunct assistant professor at the Duke-NUS Graduate Medical School and a visiting consultant at the National Cancer Centre Singapore.

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The Hepatobiliary-Pancreatic System
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