Liver

Liver Tumours can be subdivided into benign and malignant tumours. Benign tumours include benign Hepatic Adenoma, Focal Nodular Hyperplasia, Hemangioma and Regenerative Nodules. Malignant tumours include Hepatocellular Carcinoma (HCC), Cholangiocarcinoma  or Metastatic tumours from other cancers.

Liver Tumours can grow gradually in size, giving rise to chronic pain over the right upper quadrant as the liver capsule gets stretched out. Acute pain can occur in the setting of a ruptured tumour or acute bleeding into the tumour. Other symptoms include jaundice (yellowing of the skin and eyes) and loss of weight.

All Liver Tumours need to be thoroughly investigated as the risk of cancerous change is significant. A dedicated CT or MRI scan of the liver is essential. A Gastroscopy and Colonoscopy may also be needed

 

Hepatitis is acute inflammation of the liver. The causes include a viral infection, drug-related, alcohol-related and autoimmune hepatitis. Common viral infections in our local context include the Hepatitis A, B and C viruses and the dengue virus.

Alcoholic Hepatitis usually occurs in the context of acute binge drinking or chronic alcoholism. A variety of drugs can cause hepatitis and these include traditional herbal medications that may contain adulterated ingredients. Autoimmune Hepatitis is caused by auto-antibodies generated in the context of autoimmune diseases. Severe hepatitis in both acute and chronic context can lead on to liver failure and need for liver transplant.

Viral Hepatitis usually present with right upper quadrant pain, fever and jaundice. Alcoholic gastritis has similar symptoms though fever is absent.

A Liver Abscess is a collection of pus within the liver. Liver abscesses tend to occur more commonly in diabetics or in the context of gallstone-related complications. The common bacterial causes of liver abscess include E.Coli and Klebsiella. Amoebic liver abscess is uncommon in our part of the world.

The symptoms of a Liver Abscess include high unremitting fever with chills and shivering, right upper quadrant pain and occasionally jaundice in severe cases.

Urgent treatment is needed to prevent the infection from spreading further beyond the liver and into the bloodstream. This usually requires a drainage tube to be placed into the abscess to allow the pus to drain out. In addition, a prolonged period of intravenous and subsequently oral antibiotics is needed.

 

Liver Cirrhosis refers to the slow process of liver hardening and shrinkage. The most common causes in our local context are Hepatitis B, Hepatitis C and chronic alcohol consumption. Liver Cirrhosis leads to disorganised blood and biliary flow which in turn leads to development of liver failure, fluid in the abdomen (ascites), jaundice and varices (enlarged veins) with risk of sudden and life-threatening bleeding. Liver cirrhosis can also lead to the development of liver cancer.

There are no symptoms associated with Liver Cirrhosis till the later stages whereby there may be yellowing/jaundice of the skin and eyes, abdominal swelling and chronic feeling of lethargy. Sometimes, an acute episode of vomiting of blood or passage of black stools can be the first presentation of Liver Cirrhosis. In very late presentations of Liver Cirrhosis, the patient may actually be in a comatose state due to liver failure.

Individuals who are known Hepatitis B or C carriers or with family members who are known carriers need to be screened and undergo long term surveillance.

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