Liver Cirrhosis Treatment

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Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

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What Is Liver Cirrhosis?

Liver cirrhosis is a chronic liver disease characterised by the scarring of liver tissue, leading to impaired liver function.

This condition is often a result of long-term damage and inflammation in the liver caused by various factors such as chronic alcohol abuse, viral infections (hepatitis B and C), fatty liver disease, autoimmune conditions, or certain genetic disorders.

Symptoms of Liver Cirrhosis

The symptoms of liver cirrhosis can vary depending on the stage of the disease.

Early Symptoms

  • Fatigue and weakness
  • Loss of appetite
  • Nausea
  • Weight loss
  • Small, red spider-like blood vessels on the skin
Symptoms As Cirrhosis Progresses

  • Fluid buildup in the legs (edema) and abdomen (ascites)
  • Yellowing of the skin, mucous membranes, or eyes (jaundice)
  • Redness on the palms of the hands
  • Easy bruising and abnormal bleeding
  • Confusion or problems thinking
  • Pale or clay-coloured stools
  • Male breasts and shrunken testes in men
  • Irregular menstrual periods in women

In more severe cases, symptoms can include vomiting blood, tea-coloured urine, itchy skin, swelling in the legs, personality changes, memory loss, and difficulty concentrating. If you experience any of these symptoms, it is important to seek medical attention immediately.

Causes Of Liver Cirrhosis

Liver cirrhosis, a condition marked by irreversible liver scarring, comes from various causes:

  • Alcohol-related liver disease

    Drinking excessive amounts of alcohol over many years can lead to cirrhosis.

  • Hepatitis

    Long-term infection with hepatitis B or C viruses can cause cirrhosis.

  • Non-alcoholic fatty liver disease (NAFLD)

    A severe form of NAFLD, called non-alcoholic steatohepatitis (NASH), can cause cirrhosis due to excess fat buildup in the liver.

  • Bile duct disorders

    Problems affecting the bile ducts, such as primary biliary cholangitis, can cause cirrhosis.

  • Immune system issues

    Certain inherited conditions and long-term use of certain medications can cause cirrhosis.

Diagnosis of Cirrhosis

The diagnosis of cirrhosis involves a combination of medical history, physical examination, and various tests.

Medical History

Doctors may ask about symptoms, alcohol use, prescription and over-the-counter medications, herbal supplements, family history of liver conditions, and any recent changes in weight or appetite.

Physical Examination

Doctors may look for jaundice (yellowish tint to the whites of the eyes and skin), rashes, swelling in the legs, tremors, an enlarged liver, and other signs of liver damage.

Blood Tests

Liver tests can show if liver enzyme levels are higher or lower than normal, indicating liver damage. Complete blood count (CBC) can show signs of infection and anaemia caused by internal bleeding. Tests for viral infections like hepatitis B or C, and autoimmune liver conditions may also be conducted.

Imaging Tests

Ultrasound, CT, MRI, or transient elastography scans can provide liver images to assess its size, shape, and abnormalities. These tests can also help detect scarring (fibrosis) or other signs of cirrhosis.

Liver Biopsy

It may be performed to remove a sample of liver cells for examination under a microscope. This can help confirm the diagnosis and assess the severity of cirrhosis.

If cirrhosis is suspected, seeing a doctor for proper diagnosis and evaluation is essential. Early detection and appropriate treatment can help slow the progression of the disease and manage symptoms effectively.

Get an Accurate Diagnosis & Specialised Treatment For Your Condition Today

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Surgical Treatment Options

Surgical treatments for liver cirrhosis provide different procedures to handle complications and treat the root causes of the disease.

Liver Resection

Liver resection is considered in the presence of a liver tumour in the setting of liver cirrhosis.

Liver Transplant

In advanced cases of cirrhosis where the liver stops functioning properly, a liver transplant may be the only treatment option. A liver transplant involves replacing the diseased liver with a healthy liver from a deceased donor or with part of a liver. Liver transplants are typically considered for patients with small tumours or resectable cancers.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

This procedure involves creating a shunt to redirect blood flow in cases of portal hypertension to reduce pressure in the veins supplying the liver.

Band Ligation

For varices (swollen blood vessels), doctors can tie a special rubber band around them to stop bleeding.

Non-Surgical Treatment Options

Non-surgical treatments for liver cirrhosis focus on managing symptoms and preventing complications.

  • Lifestyle Changes
    Your doctors may recommend lifestyle changes to prevent further liver damage. This includes stopping alcohol consumption for alcohol-associated liver disease, weight loss for nonalcoholic fatty liver disease, and cessation of medications causing cirrhosis.
  • Medications
    Prescription of antiviral medications for chronic hepatitis B and C, immunosuppressants for autoimmune hepatitis, and weight-loss treatments for nonalcoholic fatty liver disease.
  • Portal Hypertension
    Treatment with medications to lower high blood pressure in the portal vein and procedures to address complications like ascites (abdominal swelling) and varices (enlarged veins).
  • Ascites and Edema
    Prescription of diuretics to remove excess fluid from the body, sodium restriction, and drainage of fluid buildup if necessary.
  • Varices
    Medications to lower blood pressure in veins to prevent bleeding and procedures to stop bleeding if varices rupture.

Diet Management Of Liver Cirrhosis

Eating, diet, and nutrition are important in managing liver cirrhosis. The following are some key points to consider.

Eating More Calories and Protein

People with cirrhosis may need more calories and protein to meet their body’s energy demands, as their liver can no longer store glycogen effectively. Foods rich in protein include beans, pulses, nuts, eggs, dairy products, fish, lean cuts of meat, and poultry.

Eating Smaller Frequent Meals

Cirrhosis patients can benefit from eating smaller, more frequent meals throughout the day, known as “grazing”. This helps prevent the body from breaking down muscle protein for energy.

Limiting Certain Foods and Drinks

Avoid foods and drinks that are difficult for the liver to process, such as those high in unhealthy fats, alcohol, raw or undercooked meat, eggs, seafood, and high sodium foods. Additionally, people with cirrhosis are to avoid sugary drinks, especially those containing fructose.

Managing Fluid Retention

In cases of ascites (abnormal fluid buildup in the abdomen), reducing salt intake can help reduce fluid retention. This can be achieved by avoiding adding salt to food and using it sparingly in cooking, as three-quarters of the salt.

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Dr Thng Yongxian

MBBS (SG)

MMed (Surg)

MRCS (Ire)

FRCSEd (Gen)

FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery,
    National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

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    820 Thomson Road, #06-05 ,Singapore 574623

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    Frequently Asked Questions (FAQ)

    How can diet help manage cirrhosis?

    A balanced diet is essential for people with cirrhosis. Avoiding salty foods and limiting salt intake can help reduce the risk of fluid retention. Ensuring adequate protein intake from lean sources such as beans or lentils is also important. Salt restriction is recommended to less than two grams of total daily intake.

    Why are vaccines important for cirrhosis?

    Vaccinations are crucial for patients with cirrhosis to prevent complications from certain infections. Recommended vaccinations include hepatitis A and B, pneumococcal (pneumonia) vaccine, and annual flu shots.

    Is liver cirrhosis a cancer?

    Liver cirrhosis is not a form of cancer. Cirrhosis is a condition characterised by severe scarring of the liver, which is a result of long-term liver damage from various causes like alcohol abuse, viral infections, or obesity.

    How can I slow or reverse cirrhosis?

    In some cases, damage to the liver can be slowed, but complete reversal is generally not possible. Abstaining from alcohol, losing weight for fatty liver disease, and treating underlying causes like hepatitis C can help improve liver function.

    How can obesity contribute to the development of liver cirrhosis?

    It promotes conditions like NAFLD, insulin resistance, hepatic inflammation, fibrosis, metabolic liver disease, and sarcopenic obesity. Managing obesity through weight loss interventions and lifestyle changes is crucial in preventing the progression of cirrhosis in at-risk people.

    What can I take for the pain if I have cirrhosis?

    Cirrhosis makes it more difficult for your liver to process medicines. For this reason, seek a qualified hepatologist before taking any medicines, including non-prescription ones. Don’t take aspirin and ibuprofen (Advil, Motrin IB, others). If you have liver damage, a hepatologist may recommend that you not take acetaminophen (Tylenol) or take it in low doses for pain relief.

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