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Liver and Hepatobiliary



In Asia, the prevalence of liver diseases is high. Conditions like jaundice, fatty liver associated with obesity, high alcohol consumption and metabolic conditions like high cholesterol and diabetes, to liver cirrhosis and cancer can all cause damage to the body’s Hepoto-Pancreato-Biliary (HPB) system – yet few understand its importance.


Made up of the liver, pancreas, bile ducts and gallbladder, each organ is intrinsically related, and they are all essential to the body’s digestive system. Together, they are responsible for over 3600 functions in the body, including processing food, absorbing nutrition and disposing off toxins and waste. Taking care of your HPB system through early detection is vital to empower patients to seek the right care.






The liver is a vital organ, without which the tissues of the body would quickly die from lack of energy and nutrients. It performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. It is also the only organ in the body that has an incredible capacity for regeneration of dead or damaged tissues and it is capable of growing quickly to restore its normal size and function.



Fatty liver and hepatitis B are the two most common liver diseases in Malaysia. A lifestyle-related liver condition, fatty liver could be the result of a sedentary lifestyle, inadequate activities and eating too much leading to an increase in body mass index (BMI). The risk factor of diabetes also negatively impacts the condition.


Hepatitis B is a disease characterised by the inflammation of the liver. The disease can progress to fibrosis (scarring) and cirrhosis or liver cancer. Since the prescription of a universal vaccination against hepatitis B, there has been a significant drop in incidences.


To determine the health of the liver, by running a liver function test or a group of blood tests to detect inflammation and damage to the liver, even if there is no significant sign of liver discomfort, in particular for individuals who belong to the high-risk group – those with bad food habits, who lead sedentary lifestyles, with high BMI, diabetic patients, as well as individuals with family members who have liver conditions or are carriers of hepatitis B.


Once any liver disorder is detected from the blood tests, an ultrasound and further blood test will be prescribed to determine how advanced the condition is. After the liver condition has been determined, the next step is to prescribe treatment to prevent further injury to the liver, as well as to reduce the risk of downstream conditions.


Fatty liver can be prevented from escalation with oral medication and lifestyle modification. Patients who are motivated to reduce calorie intake and exercise can reverse the liver condition. In fact, lifestyle changes are often more effective than medication.


In the case of hepatitis B, if the virus is active and there is ongoing injury to the liver, treatment is necessary and this comes in the form of antiviral oral medication. Thereafter, regular blood tests will be done to determine if the condition is under control.


Surgery becomes necessary in two situations, when liver cirrhosis leads to liver cancer, the operation only removes the cancer and leaves the remaining functioning liver and if liver disease leads to liver failure, usually at end stage liver cirrhosis in which case a transplant is needed. Liver transplantation is a surgical procedure whereby a diseased or failing liver is removed and replaced by a whole new liver from a cadaveric donor or part of a healthy liver from a living donor.


Although liver transplant is considered as the last option for patients with end-stage liver disease, nonetheless it offers patients hope for a second chance at life. Common types of liver transplantation are cadaveric and living donor liver transplantation.


In Asia, the prevalence of liver diseases are high, and there is an increasing demand for liver transplantation for patient with end-stage liver disease, not to mention a worldwide shortage of cadaveric (non-living) livers with a long waiting list in every country. Hence, Living Donor Liver Transplant (LDLT) has become an effective option for patients suffering with rapidly progressive liver disease like hepatocellular carcinoma (HCC) (the most common type of liver cancer), waiting for a deceased donor liver is often not ideal as that can take a long time. Without LDLT, such patients can develop fatal complications.