Liver cirrhosis is a chronic condition in which normal liver tissue is replaced by scar tissue (fibrosis), gradually impairing liver function. Because symptoms may be subtle or nonspecific in the early stages, many patients in Singapore are diagnosed late—when complications have already developed.
This article outlines early warning signs of liver cirrhosis and highlights when to seek specialist assessment.
What Causes Liver Cirrhosis?
Cirrhosis develops after years of ongoing liver injury. The most common causes include:
- Chronic hepatitis B or C
- Alcohol-related liver disease
- Non-alcoholic fatty liver disease (NAFLD)
- Autoimmune or metabolic conditions such as haemochromatosis or Wilson’s disease
Over time, persistent damage leads to scarring that affects blood flow through the liver. As the condition advances, this can result in portal hypertension, fluid buildup (ascites) and eventually liver failure.
Watch For These Early Symptoms
Cirrhosis often develops silently, with few or no symptoms in its early stages. However, some patients may develop:
1. Fatigue or Weakness
Persistent tiredness, even with adequate rest, is commonly reported. This may be due to the liver’s reduced ability to metabolise nutrients and toxins.
2. Unexplained Weight Loss or Poor Appetite
Individuals may notice reduced interest in food or early satiety, sometimes with weight loss over weeks or months.
3. Abdominal Discomfort or Fullness
Some may experience bloating or mild pain in the upper right quadrant of the abdomen as the liver becomes enlarged or scarred.
4. Nausea or Indigestion
The liver’s diminished detoxifying function can cause gastrointestinal symptoms, including indigestion and nausea.
5 Easy Bruising or Bleeding
As the liver produces fewer clotting proteins, patients may bruise easily or experience prolonged bleeding from minor cuts.
6. Itchy Skin (Pruritus)
The accumulation of bile salts beneath the skin can trigger persistent itchiness, sometimes even before jaundice appears.
How Cirrhosis Is Diagnosed
Early diagnosis is crucial to delay progression and prevent complications. Tests may include:
- Blood tests for liver enzymes, clotting factors and bilirubin
- Ultrasound or MRI to assess liver texture and rule out masses
- Liver transient elastography (FibroScan) to measure liver stiffness
- Liver biopsy, when needed for confirmation
At Mount Elizabeth Medical Centre, Dr Kieron Lim, Senior Consultant Gastroenterologist and Hepatologist, regularly assesses patients with suspected liver cirrhosis. He performs diagnostic procedures such as OGD, colonoscopy and FibroScan, and monitors disease progression through tailored treatment plans.
Why Early Detection Matters
Without intervention, cirrhosis may progress to:
- Decompensated cirrhosis, marked by jaundice, fluid buildup, gastrointestinal bleeding or hepatic encephalopathy
- Liver cancer (hepatocellular carcinoma)
- Liver failure, which may require transplant assessment
President of the Gastroenterological Society of Singapore, Dr Kieron Lim, stresses the importance of identifying early signs and referring patients for timely specialist input.
When to See a Specialist
If you notice any of the symptoms listed, especially in the context of known risk factors (e.g. viral hepatitis, fatty liver or alcohol use), it is advisable to consult a hepatologist or gastroenterologist.
Early lifestyle changes, targeted treatment and monitoring can help preserve liver function and improve long-term outcomes.
Final Thoughts
Liver cirrhosis does not always present with dramatic symptoms in its early stages. Subtle changes—such as fatigue, poor concentration or unexplained bruising—should not be overlooked. In Singapore, early specialist care goes a long way in delaying progression and preventing unpleasant complications.
For assessment and ongoing management of liver conditions, including cirrhosis, Singaporeans may consult Dr Kieron Lim Gastroenterology at Mount Elizabeth Medical Centre. Dr Lim is a Senior Consultant Gastroenterologist and Hepatologist who also oversees the Liver Transplant Programme at Mount Elizabeth Hospital.
