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Liver Cirrhosis Treatment

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
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.

Chronic Liver Diseases

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

Symptoms of Liver Cirrhosis

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

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.

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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.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

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).

Corporate & Personal Insurance Plans

Navigating the financial aspects of healthcare can be overwhelming. Allow us to assist you with your insurance claims, enabling you to concentrate on recovery & getting well. Our friendly clinic staff is here to answer any questions you have about insurance or payment options.

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Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

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