For consumers:

(Key words: liver diseases, Taiwan, )

• In Taiwan, with a population of 2.3 millions, the liver disease is a common disease. It had been a higprevalent endemic area of HBV infection with carrier rate of 15~20 % in general population before the government began to enforce the nation-wide vaccination against HBV on all new born babies in July 1985 (only for newborn babies born to HBsAg-positive mother in 1984).
• Fifteen years after the enforcement of nation-wide vaccination, it has been proved to be a successful method for controling HBV infection in a high-prevalent endemic area.
• Taiwan was also a high-prevalent endemic area of HAV infection before 1981 with 95 % of population having been infected with HAV before 15 years of age. However, the improvement in the environmental sanitation in western plain region of Taiwan had eradicated the HAV infection, and at present very rare cases have been proved to have infected with HAV below 25 years of age population.
• Since 1992, the screening test for HCV has been enforced on transfusion blood, very rare cases of new HCV have been found.
• Nevertheless, the liver disease is still a common disease for adult population who had contracted with HBV and HCV before the enforcement of vaccination and blood screening.
• When the doctors in Taiwan examine a patient with a liver disease, they shall consider and proceed the diagnosis according to the process shown as the followings in the "for professionals" section.

For professionals:

• In Taiwan, when you examine a patient with liver disease, the first thing you must consider is the stage of his/her liver disease,

  1) whether it is in the stage ofacute or chronic hepatitis,
  2) or has already progressed into the stage of cirrhosis,
  3) or has developed into hepato-celluar carcinoma.

  Because, in Taiwan, the most common cause of liver disease is in the order of:

  1) infection with hepatitis viruses, and
  2) alcohol origin comes to the next,
  3) while drug or chemical caused hepatitis is rather difficult to diagnose because of the difficulty to spot the definite cause.

• After suffering from hepatitis virus (B, C) infection, it is not uncommon

  (B: 90% of those infected from e-antigen positive carrier mothers, and 50% of those infected from carrier mothers or in the early stage of life; C: 50 ~ 70% of those infected in adult life)

  to become chronic carriers, and some of them further progress into chronic hepatitis, cirrhosis, and finally progress to the hepato-cellular carcinoma in the following 20~40 years.

• Therefore, when you examine a liver patient, you should consider first

  (whether he/she is suffering from an acute or chronic hepatitis, then consider about whether he/she has developed into the stage of cirrhosis or hepato-cellular carcinoma, finally you must detect the cause. )

• If you fail to find the cause of liver disease, then you have to consider about other rare causes of liver disease.

• On performing an abdominal sonography, it is not uncommon to find hepatic hemangiomas or cysts after the clinical application of sonographic technique became a routine procedure in clinical practice.

Classification of liver diseases by its cause and stage

• (A) acute, chronic, and fulminant hepatitis
  1. Viral (A, B, C, D, E, F ?, G, and TTV)
  2. Alcoholic
  3. Drug-induced
  4. Industrial and environmental toxin
  5. Autoimmune

• (B) Cirrhosis
  1. Hepatitis induced
  2. Idiopathic
     (Primary biliary cirrhosis, Hemochromatosis, Wilson's disease, Alpha-1-antitrypsin deficiency)

• (C) Tumor
  1. Malignant:
     (Hepatocellular carcinoma, Cholangiocellular carcinoma, Metastatic carcinoma)

  2. Benign:
     (Hemangioma, Cyst)
  

  [Old Doc's Home-Chinese] [Old Doc's Home-English] [Home - liver disease] [Web sites for medical students] [Currriculum Vitae ]

  (TMN) Since June 09, 2002
  (Dr. Wu's Liver D) Since Feb. 04, 1998
  (Olddoc)Since Jan. 24, 2003
  (TMN) Since Jan. 24, 2003
  (PBL) Since Mar. 11, 2003
  (By Jau-Shin Wu, M.D.;Posted Sep. 1996; Revised April 08, 2004 )