Screening of Liver diseases

Liver Diseases
Screening of Liver diseases
By Dr. Lee Ser Yee
Many diseases affecting the liver, pancreas, gallbladder and bile ducts do not display symptoms until they are in the late stages. By the time symptoms appear, the organs may have already suffered significant damage. One way to detect such diseases early is to go for regular health screening.

A comprehensive health screening includes tests that can detect liver, pancreas, gall bladder and bile duct diseases during the early stage, when treatment tends to be more effective. Routine screening for the general population or certain at-risk groups has proven benefits in certain diseases such as hepatitis, fatty liver and liver cancer.

Hepatitis

Hepatitis is the inflammation of the liver, which may be due to fatty liver, viruses such as hepatitis B or C virus or excessive alcohol intake. Patients with hepatitis may feel tired, or have loss of appetite, abdominal discomfort or develop jaundice. Chronic Hepatitis B/C can lead to liver cirrhosis, liver failure and increase the risk of liver cancer manyfold.

A blood test can detect the existence of antibodies for hepatitis A, B and C that are generated by the immune system in response to the hepatitis virus and/or after vaccination (Hep A/B). If the test for the antibodies is found to be positive, then further tests might be carried out to confirm the existence of the hepatitis virus and its viral load. If present, there is effective treatment for Hepatitis B and C.

Liver panel

As known as liver function test, it is a set of blood test to determine the liver’s health. It can also be used to discover diseases arising from pancreas, gallbladder and bile ducts. This includes liver enzymes [e.g., Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) Alkaline phosphatase (ALP)], bilirubin and other markers of liver health (e.g., protein. albumin levels).

Abdominal ultrasound

An abdominal ultrasound is a non-invasive imaging scan to look at the solid organs in the abdomen, such as the liver, gallbladder, pancreas, spleen and kidneys. The ultrasound machine sends out high-frequency sound waves that reflect off your organs, and the reflected waves are used to form images. Unlike x-rays or CT scans, ultrasound do not expose the body to radiation.

Ultrasound of the abdomen can detect gallstones and inflammation of the gallbladder, blockages in the bile duct, fatty liver, liver cirrhosis as well as gallbladder polyps, pancreas and liver tumours.

Portal hypertension

Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major blood vessel that leads to the liver, draining from the intestines. The most common cause of portal hypertension is liver cirrhosis (scarring of the liver).

Signs & Symptoms of Portal Hypertension
  • Blood in the stools, Vomiting of blood (Gastrointestinal bleeding) - Swollen blood vessels (varices) around your stomach or rectum that developed due to portal hypertension may rupture
  • Ascites – Accumulation of fluid accumulates in your abdomen, causing swelling
  • Poor sleep cycle, confusion and not acting like you usually do - Encephalopathy
  • Jaundice - Yellowing of the skin and eyes, tea-coloured urine, pale stools, itch
  • Edema - swelling of the legs
  • Gynecomastia - enlargement of the breast tissue in men
  • Prominent, visible veins around your belly button (Caput medusa)
Diagnosis

There are several ways to diagnose portal hypertension. Patients with end-stage liver disease may present with ascites and varices and may require additional tests to confirm the diagnosis and assess its severity. These include imaging, blood tests, pressure measurement studies and endoscopy.

If you have hepatitis or liver cirrhosis, you have an increased risk of developing portal hypertension. Be aware of the symptoms and seek a liver surgeon early.

Dr Lee Ser Yee
Dr Lee Ser Yee
Senior Consultant Hepatopancreatobiliary Surgeon

MBBS, MMed (Surgery), MSc, FAMS, FRCSEd

Prior to private practice, Dr Lee Ser Yee was a founding member and Senior Consultant at the Department of Hepatopancreatobiliary (HPB) and Transplant Surgery at Singapore General Hospital (SGH). He served as the Director of the Laparoscopic programme and the Director of the Surgical Skills Training Program and the SingHealth Surgical Skills Centre.

He started his medical training at the National University of Singapore in 1996 and completed his training in General Surgery, HPB surgery and Liver Transplantation at SGH and National Cancer Centre, Singapore.

He also completed dual USA-fellowships in Advanced Laparoscopic HPB surgery and Liver Transplantation under Professor Daniel Cherqui at the New York Presbyterian Hospital-Weill Cornell Medical Center and a Complex Surgical Oncology clinical fellowship at Memorial Sloan Kettering Cancer Center in New York.

Doctor Lee Ser Yee
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