Hepatitis B, Hepatocellular Carcinoma, Hepatitis C
Liver Examination & 8 Key Questions

The 47-year old Mr. Lim is a Hepatitis B carrier. Every year, he does blood tests for monitoring his liver health conditions. The previous test results were always normal for both GOT and GPT. He therefore believes that his liver should remain healthy. Until one morning, his felt extreme stomach pains. The doctor advised him to do a liver ultrasound scan and found out his liver had a 10-cm-size tumour. This time, he was panic…

Q1: The screening of Hepatitis B is necessary after its vaccination was done before?

Since 1989, the Malaysian government has launched Hepatitis B vaccination program to new-borns whose mothers were Hepatitis B carriers. Hepatitis B screening is considered an important measure, because even if vaccine has been injected, about 1% of new-borns will still get Hepatitis B infections in uterus.

In the event, vaccination is only done after a baby is born, basically such vaccination is racing time against viruses. Moreover, there are about 5% of people are found not responding to hepatitis B vaccines, thus not producing any antibodies.

Therefore, quite often doctors recommend that, after completing each Hepatitis B vaccination, a blood test should be performed every 10 to 15 years, to determine if another round of vaccination is required.

For high-risk groups, such as drug addicts, heterosexual couples, homosexuals, and medical professionals who often exposing themselves to blood and body fluids, it is best to increase their frequency of Hepatitis B screening, especially upon receiving advice from their doctors.

Q2: How often does a Hepatitis B carrier need to be screened?

The complete liver examination includes Hepatitis B surface antigen, Hepatitis B surface antibody, Hepatitis C antibody, liver function index, alpha foetal protein, and abdominal (liver) ultrasound.

To those high-risk people – Hepatitis carriers, Hepatitis C carriers, chronic hepatitis or liver cirrhosis patients, and people with family history of liver cancer, their liver conditions should be monitored at least once every six months.

Even though there is no abnormality found in blood test, should any patients feeling uncomfortable and experiencing typical Hepatitis B symptoms such as acute anorexia, nausea, vomiting, and sometimes joint pain and rash, or jaundice, it is advisable to seek medical attention immediately.

Q3: If health check is normal. Does it mean that there is no problem with the liver?

Health check-up alone can neither determine infection of Hepatitis B or C viruses, nor any presence of liver cirrhosis and cancer. In addition, liver is an organ that is naturally resilient and resistant to stress conditions. If there is a quarter of the liver continues to function, then normal physiological state will be maintained without showing any adverse signs; because there is no nerve in the liver, patients are pain-free normally; unless inflammation of liver becomes too severe, or it reaches the stage of liver cirrhosis and end-stage cancer. No clear symptom is detected, unless a thorough liver examination is done.

Besides doing liver function test, normally, alpha-foetal-protein test and abdominal ultrasound will be required for further assessment. Alpha-foetal-protein can be regarded as tumour marker test, whereas abdominal ultrasound is used to track fibrosis or tumour.

The liver function index (GOT and GPT) can only offer us a snapshot result at the time when the blood is drawn. GOT and GPT are the most abundant enzymes in liver cells. When liver cells become inflamed or injured, GOT and GPT will seep into the blood and their values will increase. However, should liver cirrhosis or liver cancer occur, liver ceases to be inflamed, and both GOT and GPT values will return within normal range again. Therefore, we cannot solely rely on liver function index to judge our current liver conditions.

Q4: What to do if liver function test is abnormal?

If the abnormal values of GOT and GPT is greater than 2 times of the upper limit of reference values, patients must be monitored closely; if it is less than 2 times of upper limits, then regular check-up on every 3-6 months will be deemed suffice.

Besides maintaining a normal weight in our daily lives, keeping away from various blood-polluting devices, eating a balanced diet, abstaining from alcohol, and not abusing drugs, most importantly, we must protect our livers by doing regular screening with complete liver function tests.

Q5: What to do if fatty liver is found?

Fatty liver is the most common liver disease in our country. Fatty liver can also cause cirrhosis like Hepatitis B. Liver cirrhosis is a serious kind of liver damage. Patients may need liver transplants to survive.

There is no specific medicine for treating fatty liver. It is necessary to rely on self-care, by reducing body weight, starting healthier diet, and exercising more.

Take more antioxidant foods, in addition to high vitamin B, C, E foods, as well as other plant biochemicals such as polyphenols, anthocyanins, carotene and so on.

On top of improving liver’s functions, we must also stop burdening liver too. Do not drink alcohol and control consumptions of high-fat, high-sugar foods. At the same time, we must also diligently exercise.

Q6: How does the spleen enlarge?

The causes of splenomegaly ( spleen enlargement ) are mostly cirrhosis combined with swelling, because of the presence of liver cirrhosis, portal pressure increases.

The spleen is an organ that removes aging red blood cells and platelets. As a result of splenomegaly, excessive normal red blood cells are destroyed, and severe cases will cause anemic conditions. If excessive platelets are destroyed, abnormal blood coagulation may occur, resulting symptoms such as bruises or gum bleeding. There is no specific treatment for treating splenomegaly.

Some patients must undergo splenectomy to improve symptoms of anaemia and coagulation. The surgery of spleen does not cause much effects on the body.

Rarer blood diseases such as severe thalassemia, myeloid leukaemia, thrombocytopenic purpura, and malaria infection can also cause splenomegaly.

Hepatitis B patients who have splenomegaly, if they do not suffer from anaemia or coagulation abnormalities, then this medical condition will be left alone.

Q7: Hepatitis C can also cause liver cancer? What are the routes of infection?

Hepatitis C is also one of the main causes of liver cancer. Most of the people who have liver cancer in our country are Hepatitis B carriers, and only minorities are Hepatitis C carriers.

Generally, Malaysians are having very little knowledge on these two types of hepatitis. Hepatitis C virus is transmitted through blood. Therefore, it is possible to infect humans with Hepatitis C viruses, such as contamination needles, syringes, blood or blood that are contaminated, blood preparations, or equipment that has not been completely sterilized. Such as razors, toothbrushes, nail clippers, scraping panels, or mothers infected with Hepatitis C viruses may also capable of infecting their foetus vertically, mother and child vertical infection rate is hovering around 6%.

Q8: What tests must be done to detect liver cancer?

As long as it is a high-risk group of liver cancer, it must be screened regularly.

What are the symptoms of liver cancer?

The liver is a silent organ. In the early stage of liver cancer, there is usually no symptoms. Since the liver has only nerves on the surface, when the tumour grows in the liver at early stage, there is often no pain or obvious symptoms. Pains only begin when tumour becomes too large, and presses nerves on surface of liver, causes jaundice, poor appetite, rapid weight loss and other symptoms. At this juncture, the options of treatments are quite limited actually.

During the end stage of liver cancer, in addition to the pain in the right upper quadrant, it is rather common patients also showing symptoms of fatigue, fever, jaundice (especially yellowing of the white eyes), and abdominal ascites ( build-up of fluids ); if the liver tumour start pressing blood vessels, the patient will suffer malabsorption followed by malnutrition, eventually resulting drastic drop of body weight.

Liver cancer ranks third in the top 10 male cancer deaths. Because the symptoms of early liver cancer are unclear, those with family history of hepatitis and liver cancer should be actively monitored, checked and tracked regularly to reduce their risk of suffering liver diseases in future.

Note : This article is meant for reference of public only. Should you have any question after reading it, please consult medical professional.
Source : Original article is printed by Sin Chew Daily, Malaysia.