Hong Kong Hepatitis, Fatty Liver & Liver Conditions
Brief, factual descriptions of conditions that may be discussed during a gastroenterology consultation.
Hong Kong gastroenterology and hepatology information from Dr Paul Ng. Consultations in Central and Tsim Sha Tsui are by appointment; assessment and care are individual.
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Liver
Hepatitis B
Hepatitis B is a virus that infects the liver. Infection may resolve or persist; chronic hepatitis B can cause ongoing inflammation, scarring, cirrhosis and liver cancer, often without symptoms for years. A set of blood tests distinguishes current infection from past exposure or vaccination and can help assess viral activity and liver injury.
Hepatitis B surface antigen, antibodies and viral DNA answer different questions; interpretation usually requires the full panel and sometimes repeat testing. Chronic infection can fluctuate, so monitoring can remain important even when a person feels well or a single set of liver tests is normal. Treatment suppresses viral activity for many people but does not always remove the virus, so follow-up may continue. Vaccination protects people who are not immune. Avoid sharing needles, razors or toothbrushes that may carry blood; casual contact, sharing meals and hugging do not transmit hepatitis B. People with chronic infection can discuss testing for household and sexual contacts, vaccination if they are not immune, and practical ways to prevent blood exposure. Do not stop prescribed antiviral therapy without medical advice, since viral activity can rise after treatment is interrupted. People with hepatitis B can feel entirely well while infection remains active, so follow-up should not depend on symptoms alone. Discuss pregnancy planning, other liver conditions and medicines with the clinician, as these may change the timing or type of monitoring.
For discussion in consultation
The pattern over time matters, so a single result may not define the phase or need for treatment. Clinicians consider viral measurements, liver tests, fibrosis, age, family history and other health factors when discussing monitoring or antiviral therapy. Some people need regular liver-cancer surveillance. The virus spreads through blood, sex or around birth, not ordinary social contact; household and sexual contacts can ask about testing and vaccination.
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These links are general information, not a recommendation for an examination or treatment.
Hepatitis C is a blood-borne virus that can persist for years and gradually scar the liver, usually without obvious early symptoms. An antibody test shows that a person has encountered the virus, but does not by itself show whether infection remains; an HCV RNA test checks for virus currently in the blood. Modern direct-acting antiviral medicines cure most infections.
A reactive hepatitis C antibody indicates exposure at some point, while an RNA test determines whether virus is currently detectable. Modern oral antiviral courses are generally finite and highly effective, but the appropriate medicines depend on liver status, prior treatment, other conditions and possible drug interactions. A follow-up RNA test confirms cure; antibody results often remain positive after cure and do not mean infection is still present. Those with cirrhosis need ongoing liver care, including cancer surveillance where indicated, because eliminating the virus does not erase established scarring. Reinfection is possible after cure if there is a new blood exposure, so prevention advice remains relevant. A clinician can also review other blood-borne infection testing and whether close contacts may need assessment based on their own exposures. A past positive antibody remains a marker of exposure and cannot be used to check for reinfection; RNA testing is needed when current infection is in question. Review all medicines and supplements before antiviral treatment because interactions can affect safe selection.
For discussion in consultation
If RNA is detected, assessment includes liver health, possible fibrosis, other conditions and medicines that could interact with treatment. The treatment course and follow-up are selected for the individual, and cure is confirmed with a later RNA test. People with advanced fibrosis or cirrhosis may still need liver-related follow-up after cure. Avoid sharing items that may have blood on them and discuss exposure concerns with a clinician.
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These links are general information, not a recommendation for an examination or treatment.
Steatotic liver disease means excess fat is present in liver cells. It is commonly associated with metabolic factors such as diabetes, cholesterol abnormalities or excess body weight, though alcohol, medicines and other causes also need consideration. Some people have fat without progressive injury; in others, inflammation can lead to fibrosis over time. The condition often causes no specific symptoms.
The term MASLD is used when steatotic liver disease occurs with at least one cardiometabolic risk factor; other causes, including alcohol exposure and medicines, should also be reviewed. Imaging can detect fat but cannot reliably determine inflammation or stage fibrosis. Blood tests may be normal despite significant scarring, which is why clinicians may use a sequence of risk scores and stiffness imaging. Cardiovascular health is also important because metabolic risks affect the heart and blood vessels. Any change in weight, diet, activity or medicines should be discussed in a way that is safe and sustainable for the individual. Improving blood pressure, glucose and cholesterol may form part of overall care, even when liver symptoms are absent. The goal is not to blame a person or recommend a one-size-fits-all diet, but to identify modifiable risks and agree on realistic follow-up. Fat on imaging does not establish the cause or show whether scarring is present. Reviewing metabolic health, alcohol intake and medicines together helps avoid overlooking other contributors and makes any follow-up assessment more meaningful.
For discussion in consultation
Evaluation may include reviewing alcohol and medication history, metabolic health, blood tests and imaging, then estimating fibrosis risk rather than relying on liver enzymes alone. Management is individualized and may address contributing metabolic conditions and sustainable health habits. A normal blood test or an ultrasound showing fat cannot by itself establish how much scarring is present; follow-up depends on the full risk profile.
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These links are general information, not a recommendation for an examination or treatment.
MAFLD is an older name and diagnostic framework for fatty liver associated with metabolic health changes, such as excess weight, type 2 diabetes or metabolic risk. It is not exactly interchangeable with the newer term MASLD, which uses a different definition and criteria. Both describe fatty liver in a metabolic context; “fatty liver” on imaging alone does not establish the cause or show whether inflammation or scarring is present. Alcohol, medicines and other liver conditions may also contribute.
MAFLD was an earlier proposed diagnostic framework that used evidence of fatty liver plus metabolic dysfunction; it is not simply another spelling of MASLD, which has updated consensus criteria. Older records may use MAFLD, while current assessment may apply newer terminology. Neither label alone reveals the amount of inflammation or fibrosis, and fatty liver can have more than one contributing cause. Ask the clinician what the original diagnosis was based on and whether current evaluation changes the risk assessment.
For discussion in consultation
A clinician reviews the basis for the original MAFLD label, metabolic health, alcohol and medicine history, and tests for other causes where appropriate. Blood tests and imaging can identify fat and help estimate scarring risk, but normal liver enzymes do not rule out fibrosis. Follow-up and care are tailored to the overall health picture rather than the label alone; the clinician can clarify whether current terminology or further assessment is relevant.
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These links are general information, not a recommendation for an examination or treatment.
Fibrosis is scar tissue that develops when the liver is repeatedly injured, for example by viral hepatitis, alcohol-related injury or metabolic liver disease. The amount ranges from mild scarring to advanced fibrosis; cirrhosis is the more advanced stage with changes in liver structure and blood flow. Early fibrosis may cause no symptoms.
Noninvasive risk scores use routine blood results and clinical information, while elastography estimates tissue stiffness; neither provides a perfect map of liver scarring. Stiffness can rise temporarily with inflammation, bile-flow problems or congestion, and blood-based scores can be affected by conditions unrelated to the liver. If results are inconsistent or uncertain, repeat measurement, another imaging method or occasionally biopsy may be discussed. Understanding and addressing the cause of liver injury is central, since fibrosis risk and the need for follow-up depend on both its stage and whether the cause continues. A low-risk estimate can support less intensive follow-up in some circumstances, but it does not remove the need to manage the underlying condition. A clinician can explain what a specific score means and whether it should be repeated after other health issues are addressed. A stiffness measurement is one part of a risk assessment, not a stand-alone verdict about liver function or future outcome. Ask how the result compares with blood tests and prior measurements, and whether addressing a temporary cause before repeat testing would improve interpretation.
For discussion in consultation
Blood-based scores and imaging tests that measure liver stiffness can estimate the likelihood of significant scarring without taking a biopsy. They are not direct photographs of every part of the liver, and inflammation, congestion or other factors may influence results. Clinicians interpret them alongside blood tests, medical history and possible causes, then decide whether repeat assessment or specialist review is useful.
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These links are general information, not a recommendation for an examination or treatment.
Cirrhosis is advanced liver scarring that distorts the liver and can restrict blood flow through it. Some people feel well for a long time, while others develop complications such as abdominal fluid, enlarged veins that can bleed, confusion or jaundice. Causes include chronic viral hepatitis, alcohol-related injury and metabolic or autoimmune liver disease.
“Compensated” cirrhosis means major complications have not developed, whereas “decompensated” cirrhosis describes events such as fluid build-up, bleeding or confusion. This distinction helps clinicians estimate risk and plan care but can change over time. Follow-up may include assessment of liver function, portal hypertension, nutrition and medicines, as well as regular liver-cancer surveillance when appropriate. Vaccination and avoiding alcohol or medicines that could worsen liver injury may be discussed for an individual. Vomiting blood, black stools, sudden confusion, fever with abdominal swelling or rapidly worsening jaundice are emergencies. A written record of medicines and the care team’s monitoring plan can help coordinate follow-up across clinicians. New swelling, worsening sleepiness or reduced appetite should be reported, since early review may help identify a developing complication. The care team can explain which changes should trigger same-day advice and which appointments or scans are planned routinely. Keep an up-to-date medicine list and tell clinicians about new medicines, as liver function can affect how some drugs are handled.
For discussion in consultation
Care considers the cause, liver function and whether complications or portal hypertension are present. Evaluation may include blood tests, imaging and endoscopy, with monitoring for liver cancer and prevention or management of complications where indicated. Treating the underlying cause can still be important. Vomiting blood, black stools, new confusion, fever with abdominal swelling or rapidly worsening jaundice requires urgent medical attention.
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These links are general information, not a recommendation for an examination or treatment.
AIH is an immune-mediated inflammation of the liver. It can present with few symptoms, fatigue or jaundice, and may be discovered through abnormal liver blood tests; untreated ongoing inflammation can lead to fibrosis and cirrhosis. No single antibody or test proves AIH, and similar findings can occur in other liver conditions.
AIH is diagnosed from a combination of biochemical, immunological and sometimes tissue findings after other causes of liver inflammation are assessed. Autoantibody results are not diagnostic in isolation, and disease activity may change over time; follow-up commonly considers liver blood tests and fibrosis as part of ongoing review.
For discussion in consultation
Diagnosis draws on liver enzyme patterns, immunoglobulin levels, autoantibodies, exclusion of competing causes and often liver biopsy. Results are interpreted as a whole, since antibodies may occur in other conditions and some people with AIH have negative tests. Assessment also considers the degree of inflammation and scarring, associated autoimmune conditions and the need for ongoing monitoring.
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These links are general information, not a recommendation for an examination or treatment.
PBC is a chronic autoimmune disease that gradually damages the small bile ducts within the liver. Bile-flow impairment can cause abnormal liver tests, itching or fatigue, although some people have no symptoms when it is first detected. Persistent bile-duct injury may lead to liver scarring over time; PBC is not the same condition as blockage of a large bile duct.
PBC is often suspected from a cholestatic liver-test pattern together with antimitochondrial antibodies, after obstruction and other explanations are considered. Some antibody-negative cases require additional assessment, and biopsy is not needed in every typical presentation; long-term review may track liver tests, fibrosis and associated health issues.
For discussion in consultation
Evaluation typically considers cholestatic liver blood tests, antimitochondrial antibodies or other PBC-associated antibodies, and exclusion of alternative causes. Imaging may help assess bile ducts or other liver disease, while biopsy is reserved for selected situations when the diagnosis remains uncertain or overlap is considered. Follow-up takes account of liver test trends, fibrosis and possible complications.
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These links are general information, not a recommendation for an examination or treatment.
Liver cysts are fluid-containing findings within the liver, often noticed by chance on imaging done for another reason. A typical simple cyst has a smooth, thin wall and clear fluid appearance and is usually benign; it often causes no symptoms and needs no treatment. Less typical appearances can represent a different type of lesion and should not automatically be treated as a simple cyst.
A simple hepatic cyst is usually diagnosed by its characteristic appearance on ultrasound, CT or MRI; further tests are generally unnecessary when the features are clear and there are no relevant symptoms. Complex features such as septations, irregular thick walls, nodules or enhancement need a different assessment and may lead to dedicated imaging. Cysts are not all caused by the same process, and a report’s wording and images matter. Seek clinical review for persistent pain, fever or a change in symptoms, while remembering that these symptoms may have causes unrelated to the cyst. A typical simple cyst does not usually become cancer, and repeatedly scanning a clearly benign finding may not add useful information. If the report describes an indeterminate or complex lesion, the next step is to clarify its imaging features rather than assume the worst. If a lesion is described as complex or indeterminate, the recommended next step usually aims to characterize it with appropriate imaging rather than treating the word “cyst” as a diagnosis. Earlier scans can help establish whether its appearance has remained stable.
For discussion in consultation
The original images and report are reviewed for features such as internal divisions, thick walls, solid areas or enhancement, alongside symptoms and relevant medical history. Further imaging may be used when the diagnosis is uncertain. Pain or fullness can occur with a very large cyst, but other causes should also be considered; follow-up depends on the actual imaging diagnosis.
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These links are general information, not a recommendation for an examination or treatment.
These summaries are for general information only. They cannot establish a diagnosis or determine whether you need tests, surveillance or treatment. Your own results, risks and options must be reviewed in an actual consultation with a qualified clinician. Do not start, stop or change treatment based on this page.
References are provided for background reading; they do not replace a consultation.
Questions about a finding on your scan, blood test or endoscopy report? Discuss the full report and your history in a consultation.
About this information
This is general educational information, not a diagnosis, a personalised recommendation or consent for a procedure. Whether to investigate or treat, the alternatives (including no procedure), benefits and risks require individual clinical assessment and discussion.