Liver Fibrosis / Cirrhosis
Liver fibrosis refers to scarring caused by long-term, ongoing liver damage.
Clinical Expertise: Abdominal Pain & Bloating, Gastrointestinal Cancers, Gastroesophageal Reflux Disease, H. Pylori, Irritable Bowel Syndrome, Gallbladder Diseases
Dr. John Hsiang is a distinguished gastroenterologist, having obtained his Fellowship of the Royal Australasian College of Physicians in Gastroenterology in 2012. He holds a doctorate (PhD) in Viral Hepatitis and Fatty Liver Disease research.
Dr. Hsiang specialises in performing endoscopies and colonoscopies to investigate gastrointestinal symptoms, diagnose stomach and colon cancers, and deliver targeted treatment options.
Dr. Hsiang adheres to an evidence-based practice and a personalised approach, ensuring safe and optimal outcomes for his patients.
Languages Spoken:
English, Mandarin and Hokkien
Fellowship Trained Specialist
20+ Years of Clinical Experience
Understanding Liver Fibrosis & Cirrhosis
Liver fibrosis refers to scarring caused by long-term, ongoing liver damage.
It often develops without noticeable symptoms, but if left untreated, it can progress to cirrhosis—a more advanced stage where liver function becomes significantly impaired.
Fortunately, early-stage fibrosis may be reversible with appropriate treatment and lifestyle changes. Early diagnosis is therefore key to preventing lasting damage and preserving liver health.
What is Liver Fibrosis and Cirrhosis?
- Liver Fibrosis (Scarring)
When the liver is repeatedly injured (from causes like viruses, alcohol, or fat accumulation), it tries to repair itself by producing collagen. In chronic liver disease, this process doesn’t stop, leading to an excessive buildup of scar tissue, which makes the liver stiff. - Cirrhosis (Advanced Fibrosis)
Cirrhosis occurs when the scarring is so severe that it disrupts the liver’s structure and its ability to function correctly. This can lead to serious health complications and is a major cause of death worldwide.
Symptoms and Risk Factors at a Glance
Early Signs
- General fatigue
- Mild discomfort in the upper right abdomen
- Abnormal results on a routine liver blood test
Advanced Signs (Cirrhosis)
- Yellowing of the skin and eyes (jaundice)
- Abdominal swelling (ascites)
- Swelling in the legs
- Bruising or bleeding easily
- Confusion or memory problems
Common Causes & Risk Factors
- Chronic hepatitis B or C
- Excessive alcohol consumption
- Non-alcoholic fatty liver disease (NAFLD)
- Autoimmune liver conditions
- Family history of liver disease
Our Approach to Diagnosis
At Richmond Gastroenterology Centre, we use a combination of advanced, non-invasive tools to diagnose and stage liver fibrosis:
- FibroScan: A quick, painless ultrasound-based test that measures liver stiffness and fat content to assess the stage of fibrosis.
- Blood Tests: Specialised scoring systems (like FIB-4 and APRI) and liver function panels help estimate the degree of scarring.
- Imaging: An abdominal ultrasound, CT scan, or MRI can be used to view the liver’s size, shape and structure.
Liver Biopsy: While not always necessary, this remains the “gold standard” for confirming a diagnosis and is sometimes required to assess the exact stage and cause of the liver disease.
80-90%
Loss of Liver Function
Up to 80–90% of liver function can be lost before symptoms of cirrhosis become apparent, making early detection challenging.
50%
Rate of Progression
About 50% of people with compensated cirrhosis (no major symptoms yet) will progress to decompensated cirrhosis (with complications like ascites or variceal bleeding) within 10 years if the underlying cause is not treated.
Treatment Options
Treatment is highly individualised and focuses on managing the underlying cause to stop the progression of scarring.
- Treating the Underlying Cause: This may involve antiviral medications for Hepatitis B or C, or immunosuppressive drugs for autoimmune conditions.
- Lifestyle Modification: This is a core component of treatment. Patients are advised to avoid alcohol completely, adopt a balanced diet low in saturated fats, and manage coexisting conditions like diabetes and high cholesterol. For those with NAFLD, weight loss and exercise are key.
- Advanced Care: In cases of advanced cirrhosis with significant liver impairment, ongoing monitoring with regular blood tests and imaging is essential to manage complications and screen for liver cancer. If the condition progresses or complications arise, a referral may be required for surgical interventions such as liver resection or, in select cases, evaluation for liver transplantation.
Can Liver Fibrosis be Cured or Reversed?
Early-stage liver fibrosis may be reversed if the underlying cause is identified and treated effectively, whether related to hepatitis, alcohol consumption or fatty liver disease.
In contrast, advanced fibrosis and cirrhosis are generally permanent, although treatment can help slow or stabilise further progression.
Timely diagnosis of liver damage offers the best opportunity to stop or potentially reverse the condition before serious complications develop.
Your Journey to Improved Liver Health
Experiencing symptoms suggestive of a liver condition? Here’s what to expect when you visit our gastroenterologist:
Make an Appointment
Specialist Consultation & Diagnosis
Your Personalised Treatment Plan
Ongoing Monitoring and Care
Patient Information
What causes liver fibrosis and cirrhosis?
Liver fibrosis is typically caused by long-term liver injury due to conditions such as chronic hepatitis B or C, non-alcoholic fatty liver disease (NAFLD), excessive alcohol intake or autoimmune liver diseases.
If left untreated, fibrosis may progress to cirrhosis, which is characterised by advanced scarring and impaired liver function.
Is liver fibrosis always a sign of liver failure?
No, liver fibrosis is not the same as liver failure. In its early stages, fibrosis may not affect liver function significantly. However, if it progresses to cirrhosis without intervention, it can eventually lead to liver failure and other serious complications.
Does liver fibrosis always progress to cirrhosis?
Not always. With early intervention and appropriate management, liver fibrosis can be stabilised or even reversed. Progression to cirrhosis is more likely when the underlying cause remains untreated.
Can I live a normal life with liver fibrosis or cirrhosis?
What Is the prognosis for liver fibrosis and cirrhosis?
With early detection, appropriate treatment of the underlying cause and sustained lifestyle changes, many individuals with liver fibrosis can maintain a normal lifespan.
Prognosis depends largely on the stage at diagnosis and how effectively the condition is managed over time.
In more advanced cases, such as cirrhosis, life expectancy may be reduced, especially if complications develop. Fortunately, ongoing monitoring and medical care can help slow progression and improve quality of life.
How often should I undergo monitoring?
Monitoring schedules vary depending on the severity of liver damage and the underlying cause. Patients may require regular blood tests, imaging scans such as FibroScan or ultrasound and screenings for liver cancer (e.g., every 6 months in cirrhosis).
Can I drink alcohol if I have liver fibrosis or cirrhosis?
Alcohol is strongly discouraged in individuals with liver fibrosis or cirrhosis, regardless of the cause. Continued alcohol consumption can accelerate liver damage and increase the risk of complications, including liver failure.
What foods are beneficial for a scarred liver?
A liver-friendly diet emphasises whole, unprocessed foods that support liver function and reduce further damage. Recommended options include leafy green vegetables, fruits such as berries, whole grains, fatty fish rich in omega-3 fatty acids and nuts.
It is important to avoid alcohol, processed foods and excessive sugar, all of which can worsen liver scarring.
Consult Our Specialist
Experiencing digestive symptoms or discomfort? Speak to our gastroenterologist for a clearer understanding of your condition and treatment options.
You may book an appointment using our contact form or call the clinic at 6517 9958
