Liver cirrhosis is a major health concern in Singapore and globally, too. While it is a serious condition, there are various treatments available to help slow its progression and prevent complications.

What Is Liver Cirrhosis?

Liver cirrhosis is a condition where healthy liver tissue is replaced by scar tissue, impairing the organ’s ability to function. This chronic scarring results from sustained liver damage over time and can lead to complications such as liver failure or cancer if untreated.

Causes of Liver Cirrhosis

Cirrhosis develops gradually and can stem from various chronic conditions. The most common causes include:

• Chronic Hepatitis B or C

  These viral infections can persist for years without symptoms, eventually damaging liver cells and causing fibrosis.

• Non-alcoholic Fatty Liver Disease (NAFLD)

  This is increasingly common in Singapore, especially among individuals with type 2 diabetes, obesity, or metabolic syndrome. If NAFLD progresses to non-alcoholic steatohepatitis (NASH), inflammation and scarring may occur.

• Alcohol-Related Liver Disease

  Long-term alcohol use can damage liver cells, leading to fibrosis and eventually cirrhosis.

• Autoimmune Liver Conditions and Metabolic Disorders

  Conditions like autoimmune hepatitis, Wilson’s disease, and haemochromatosis can also cause cirrhosis if untreated.

Early and Advanced Symptoms

Cirrhosis often begins with subtle symptoms, making early detection difficult. As the condition progresses and liver damage becomes more severe, distinct complications begin to emerge.
 

Early Symptoms:

• Patients may experience fatigue, a persistent feeling of tiredness and lack of energy
• There can be a loss of appetite, leading to reduced food intake
• Individuals might notice nausea or bloating after meals
• Some may experience mild confusion or difficulty concentrating, often referred to as "brain fog.
• Unexplained weight loss can occur over weeks or months
• Itchy skin may develop due to impaired bile flow

Advanced Symptoms:

• Jaundice is a common sign, characterised by the yellowing of the skin and eyes
• Swelling can appear in the legs or abdomen, a condition known as ascites, due to fluid retention
• Vomiting blood, often from variceal bleeding in the oesophagus, is a serious complication
• Patients may experience easy bruising or prolonged bleeding due to impaired clotting
• Muscle wasting can become noticeable as the body struggles to process nutrients
• Changes in waste products can lead to dark urine or pale stool

Diagnosing Liver Cirrhosis

Cirrhosis is diagnosed through a combination of several key assessments:

Early Symptoms:

• Blood tests are conducted to evaluate liver function, including levels of ALT, AST, and bilirubin
• Imaging studies, such as ultrasound or MRI, are used to visualise the liver's structure and detect abnormalities
• Liver stiffness measurement (FibroScan) provides a non-invasive way to assess the degree of scarring in the liver
• Endoscopic evaluations may be performed to check for complications like varices
• A liver biopsy is conducted if a more definitive diagnosis or detailed assessment of liver damage is required

Liver Cirrhosis Treatment

Liver cirrhosis is generally incurable. However, some cases may be reversed when managed early. The primary goal in treating liver cirrhosis is to address and remove the underlying cause of liver injury, which can, in some cases, allow the liver to repair itself.

Treatment goals generally focus on three key areas:

1. Managing the Underlying Cause: For example, antiviral therapy is used for viral hepatitis, cessation of alcohol for alcohol-related liver disease, or lifestyle changes for non-alcoholic fatty liver disease (NAFLD).
2. Monitoring for Complications: Regular surveillance is crucial to detect and manage potential complications early, such as liver cancer (hepatocellular carcinoma) or varices.
3. Symptom Control: Various therapies are employed to manage symptoms and complications as they arise. This includes sclerotherapy to manage bleeding veins, kidney dialysis, and medications to control ascites and swelling.

In Singapore, Dr Kieron Lim, an experienced gastroenterologist, assesses and treats patients with cirrhosis at Mount Elizabeth Medical Centre. He also performs procedures such as oesophagogastroduodenoscopy (OGD), FibroScan, capsule endoscopy, and liver cancer management.

Diet for Liver Cirrhosis Prevention and Management

Dietary modifications can play a role in slowing progression and managing cirrhosis.

Recommended Dietary Practices:

• Consume balanced meals that include lean protein, whole grains, and a variety of vegetables
• Follow a low-sodium diet to help reduce fluid retention and swelling
• Ensure adequate caloric intake to prevent malnutrition, which is common in liver disease
• Drink coffee in moderation, as some studies suggest it may offer protective effects for the liver

Foods and Substances to Avoid:

• Completely abstain from alcohol in all cases of cirrhosis, as it is a major cause of liver damage
• Limit processed foods that are high in added salt, fat, or sugar
• Avoid raw seafood due to the increased risk of infection in immunocompromised patients
• Do not take herbal supplements without medical clearance, as some can be harmful to the liver

For more information on the diagnosis and treatment of liver cirrhosis, browse this article from Mount Elizabeth Medical Centre:
https://www.mountelizabeth.com.sg/conditions-diseases/liver-cirrhosis/diagnosis-treatment
 

Liver cirrhosis is a serious but manageable condition especially if promptly and properly addressed. Understanding its causes, recognising symptoms, following medical treatment, and making dietary changes can help slow disease progression. If you are at risk or are experiencing early signs, consult a liver specialist as soon as possible.