​In early or compensated cirrhosis, patients will not have symptoms and they will feel normal. They may not even know that they have liver cirrhosis. It is important that patients at risk of chronic liver injury be monitored by doctors even if they feel well. Ultrasound scan of the liver is probably the easiest way to diagnose cirrhosis.

In advanced cirrhosis, symptoms of significant liver damage may include:

• Tiredness, lethargy
  
• Jaundice (yellow colouration of the eye)
  
• A distended, fluid-filled abdomen (ascites)
  
• Swelling of the legs
  
• Presence of reddish spidery spots on the chest and back (spider angiomas) 
  
• Sleep disturbance, personality changes and confusion
  
• Vomiting of fresh blood or passing of black tarry stools
  

​In Singapore, the most common cause of liver cirrhosis is chronic Hepatitis B. While not every Hepatitis B carrier will become cirrhotic, approximately 20-40% may end up with cirrhosis if their condition is not monitored. Other causes include alcohol, hepatitis C, fatty liver with inflammation, and rarer causes such as Autoimmune Liver Disease, Primary Biliary Cirrhosis, Wilson’s disease and primary sclerosing cholangitis.

​Early liver cirrhosis does not cause problems as the liver has enough reserve capacity to cater to the needs of the body even though it is scarred.

As scarring progresses, liver insufficiency develops and the patient is prone to developing the following complications:

• Retention of water in abdomen and leg
  
• Delayed clotting and easily bruised
  
• Internal bleeding
  
• Increased risks of infection
  
• Increased risks of mental confusion
  
• Increased risks of liver cancer
  

​It is important that you consult a hepatologist who will help you confirm the diagnosis and pinpoint the cause of the cirrhosis. Many of the causes can be treated, thus preventing further injury and deterioration.

Abdomen and leg swelling

​Cirrhosis can improve and even reverse in some situations. The main aim is to remove the cause of the injury and to allow the liver to repair itself. With treatment, early cirrhosis can be detected, thus preventing further deterioration. Even when complications develop, many of these complications can be controlled and patients can be maintained at compensated stage (with relatively normal functions). For end-stage liver cirrhosis, liver transplantation provides a cure for cirrhosis patients.

• Associate Professor Alfred Kow Wei Chieh
• Professor Krishnakumar Madhavan 
• Associate Professor Iyer Shridhar Ganpathi 
• Dr Glenn Kunnath Bonney
• Dr Pang Ning Qi
• Dr Gao Yujia