While liver disorders such as fatty liver, hepatitis, and procedures related to the digestive system such as endoscopies are more commonly known, the terms ‘gastroenterology’ and ‘hepatology’ might not be as widely recognised.
Changi General Hospital’s (CGH) Department of Gastroenterology and Hepatology provides care for patients with gastrointestinal and liver disorders, including gastrointestinal bleeding, inflammatory bowel disease, acute and chronic liver disease, as well as liver cirrhosis, among many others.
“Our services are led by established specialists with expertise and training in their fields, and supported by modern equipment and facilities,” says Clinical Associate Professor Andrew Kwek, Head and Senior Consultant, Department of Gastroenterology and Hepatology, CGH. “Patients can look forward to a comprehensive assessment and patient-centred management, based on their clinical condition and needs.”
Multi-disciplinary care
At CGH, complex conditions are discussed at multi-disciplinary meetings to facilitate the best care approach for patients with them. In addition, joint or sequential clinic consultations between the gastroenterologists, hepatopancreaticobiliary (HPB) surgeons — who perform procedures that treat disorders of the liver, pancreas, gallbladder and bile duct, and interventional radiologists are conducted to help reduce the number of hospital visits and decrease waiting times for patients.
Other disciplines such as urology also help to provide holistic specialised services to patients. For example, in patients with chronic pancreatitis, stones in the pancreatic duct will undergo extracorporeal shockwave lithotripsy (fragmentation of the stone by ultrasound technique) by urology specialists who have the expertise and experience in this technology. Subsequently, advanced endoscopists will perform therapeutic endoscopy to clear the stone fragments from the pancreatic duct.
Advancing clinical research
To advance medical care for patients, the CGH care team regularly contributes to the scientific community through research collaborations and publications in numerous high-impact medical journals. “CGH doctors have also been invited to teach and share their clinical knowledge at local and international medical conferences,” says Clin Assoc Prof Kwek.
One recent collaboration was with researchers from Hong Kong and Thailand on a randomised controlled study comparing the effectiveness of hemostatic powder and standard treatment in the control of acute upper gastrointestinal bleeding. The study was published in the Annals of Internal Medicine, a high-impact factor medical journal, in 2022.
LIVER CIRRHOSIS
Liver cirrhosis is a condition where the liver becomes scarred and is unable to function normally. This can be caused by a variety of factors, including viral hepatitis, non-alcoholic fatty liver disease and long-term alcohol use.
Symptoms of cirrhosis include fatigue, weakness, loss of appetite, weight loss, nausea, yellowish discolouration of the skin and eyes (jaundice), bruising or bleeding easily, confusion, drowsiness, slurred speech, and swelling in the legs and abdomen. Liver cirrhosis can be detected through radiography imaging methods such as ultrasounds, magnetic resonance imaging (MRI) or computerised tomography (CT) scans, as well as through biopsies — the removal of a small sample of liver tissue for analysis.
If not managed or treated, cirrhosis can result in complications such as liver cancer, gastrointestinal bleeding, kidney failure, infections, increased risk of blood clots and liver failure, all of which can be life-threatening.
Patients with liver cirrhosis may also develop ascites (fluid accumulation in the belly). Ascites can be treated in various ways, such as medication, drainage of the ascitic fluid, insertion of artificial shunts that bypass the diseased liver (TIPSS) which relieves fluid build-up, and liver transplantation.
A study conducted by CGH showed that the rapid removal of ascitic fluids using a drainage catheter (within 24 hours) was associated with a lower risk of bacterial infection and kidney injury. At CGH, patients with ascites have the option to undergo the drainage of ascitic fluids and be discharged within the same day.
To prevent liver cirrhosis, avoid consuming excessive alcohol, get vaccinations against hepatitis A and B, practise safe sex to prevent hepatitis B and hepatitis C, maintain a healthy diet and exercise regularly. For patients with cirrhosis, it is important to see a doctor regularly and follow their treatment plan. Treatments may include medications, lifestyle changes, and in some cases, a liver transplant.
NON-ALCOHOLIC FATTY LIVER DISEASE
Non-alcoholic fatty liver disease (NAFLD) is a condition where excess fat accumulates in the liver of people who consume little or no alcohol, causing it to enlarge and function abnormally. This is one of the two main forms of fatty liver diseases, the other being alcohol-induced fatty liver disease, which is caused by heavy drinking.
Obesity, high blood sugar levels, hypertension, high cholesterol and diabetes are some of the common causes of NAFLD. Symptoms of fatty liver can be subtle and may include fatigue and abdominal discomfort. Some individuals with NAFLD can develop non-alcoholic steatohepatitis (NASH), an aggressive form of fatty liver disease. Patients with NAFLD may develop progressive liver disease leading to advanced scarring (liver cirrhosis) and liver failure. Furthermore, NAFLD patients also have a higher risk of developing cardiovascular-related complications such as heart attack or stroke, and cancers.
Similar to liver cirrhosis, NAFLD can be diagnosed through a range of methods such as imaging studies, blood tests and biopsies.
If not managed, NAFLD can lead to more serious problems if it progresses into liver cirrhosis. However, if properly treated and if the condition has not worsened to an irreversible stage, the liver has the ability to repair itself.
Treatments for fatty liver typically focus on addressing the underlying cause, and include weight loss and lifestyle changes to improve diet and exercise. To maintain a healthy liver and avoid fatty liver disease, it is important to maintain a healthy lifestyle, such as a balanced diet low in carbohydrate and high in fibre, regular physical activity, and limiting alcohol consumption. Avoiding exposure to toxins and undergoing regular liver function tests to monitor liver health also help prevent fatty liver disease.
When people have a headache or fever, a common medicine to take is painkillers. Many of these medicines are easy to obtain and often contain paracetamol. While it might be tempting to take more of these medicines to help with the aches, an overdose of paracetamol can cause liver injury, which is a potentially serious condition.
The recommended dosage is up to four grams, or eight tablets, of paracetamol daily. Outward symptoms of overdosing on paracetamol include nausea, vomiting, abdominal pain and dizziness. The diagnosis of paracetamol overdose-related liver injury is typically based on a combination of symptoms, medical history and blood tests to measure liver function and paracetamol levels.
Treatment for paracetamol overdose-related liver injury may include:
It is important to seek immediate medical attention if you suspect you have taken an overdose of paracetamol. Early treatment can be critical in preventing serious liver injury and improving outcomes.
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