Ask a General Surgeon: Dr Ho Choon Kiat from Mount Elizabeth (Orchard) Hospital Singapore and Mount Elizabeth Novena Hospital Singapore

Ask a Doctor ForumCategory: General SurgeryAsk a General Surgeon: Dr Ho Choon Kiat from Mount Elizabeth (Orchard) Hospital Singapore and Mount Elizabeth Novena Hospital Singapore
Dr Ho Choon Kiat asked 2 years ago
I am Dr Ho Choon Kiat, General Surgeon based in Mount Elizabeth (Orchard) Hospital Singapore, Mount Elizabeth Novena Hospital Singapore, Mount Alvernia Hospital Singapore and Parkway East Hospital Singapore. Ask Me Anything! I specialise in the treatment of liver, pancreas, gallbladder and bile duct cancers, as well as benign hepatobiliary diseases like gallstone, bile duct stone, pancreatitis, cystic tumours of the pancreas and neuroendocrine cancer. I have over 20 years experience in the field - my other clinical interests include digestive tract surgery of the stomach, small intestine and the colon / rectum, cancer surgery, laparoscopic hepatobiliary and pancreatic surgery, hernia surgery, endoscopy (gastroscopy and colonoscopy). I graduated from the Faculty of Medicine at the National University of Singapore in 1994. After my National Service, I trained in general surgery at Tan Tock Seng Hospital under Professor Low Cheng Hock. I was admitted as a Fellow to the Royal Colleges of Surgeons of Edinburgh and Glasgow in 1999. In 2003, through the Health Manpower Development Programme (HMDP) award, I undertook subspecialty training in hepatobiliary and pancreatic surgery at the Surgical Klinik of the University of Heidelberg, Germany. Under the mentorship of Professor Marcus Büchler and Helmut Friess, two of the best published pancreatic surgeons, I was trained in management of pancreatic cancer as well as cancer surgery in general. In 2004, I was awarded the TTSH Scholarship and received formal training in advanced laparoscopic surgery at the Royal Brisbane and Women’s Hospital under the mentorship of Drs Les Nathanson and Nick O’Rourke. Following my return, I started the advanced laparoscopic service which provides laparoscopic liver, pancreas and bile duct surgery. Prior to establishing my private practise, I was a consultant at the Department of Surgery, Tan Tock Seng Hospital. I was the Director of Endoscopy Centre. I served in the Ex-Co of the Chapter of General Surgeons, College of Surgeons, from 2011 to 2017. I am a founding member of the Hepatobiliary Pancreatic Association of Singapore. I am also an Adj Asst Professor with the Yong Loo Lin School of Medicine, National University of Singapore. Learn more about me here: I am excited to be here to share/discuss the treatment of liver, pancreas, gallbladder, bile duct cancers and benign hepatobiliary diseases with everyone. I will be actively answering questions. Whether you've got questions about gallstones, bile duct stones, pancreatitis, cystic tumours of the pancreas and neuroendocrine cancer, ask me anything! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
16 Answers
Renee answered 2 years ago

My son is 13 years old and he has had an autoimmune condition since he was 7 years old. Lately he has been complaining about pain in his stomach and back. His stools are also oily-looking. What makes me worried is that his skin and eyes turned yellow. It has been three days. Is this a sign of his condition getting worse? What is the effective treatment for this?

Dr Ho Choon Kiat replied 2 years ago

Thank you for your question.

It is often a step-by-step method to find the diagnosis. And the first step is based on your son’s complaints as well as his past medical history, in this case, a history of autoimmune condition. Depending on what we found in the first step, that would guide doctors in the next step.

Given his complaints, I would want to check if there is inflammation of the liver and bile duct. Autoimmune disease can affect these organs too – autoimmune hepatitis / primary biliary cirrhosis.

In addition, you mentioned that his pain goes to the back as well, and that the stools looked oily – I would also think of the pancreas as well.

Therefore, the first step would be to run a liver function test – that would tell us if he has jaundice and/or hepatitis. ALso include serum amylase and serum lipase to look for pancreas inflammation.

Look for a Gastroenterologist – this is a specialist that would be able to run such tests and interpret the results for you. This specialist would then determine the next step to take.

Treatment would depend on the diagnosis.

I hope my answer is helpful. Thanks

Charisse answered 2 years ago

My father is 63 years old and he has fatty liver that is caused by high levels of blood sugar and hypertension. Currently he is on medication to control those two conditions. The doctor said there is no inflammation. My question is what factors could cause inflammation in his case? Would it happen if his diabetes and hypertension got worse? How should he maintain his lifestyle to prevent possible inflammation?

Dr Ho Choon Kiat replied 2 years ago

Fatty liver is a condition in which there is excessive fat in the liver. Excessive alcohol intake is one of the common cause. As the fat builds up, it can cause liver inflammation, also known has steato-hepatitis.

The presence of diabetes can accentuate this process of inflammation. Therefore it is important to control the diabetes. Other then being regular with the diabetic medications, we would also advise patients to adopt certain lifestyle modifications, such as:

1. lose weight if his BMI is more than 25
2. cut down on high carbohydrate food like white rice, yellow noodles, refined bread
3. cut down on fatty food
4. avoid canned or packet drinks
5. exercise regularly; try to achieve 150 to 200mins of exercise per week
6. see a doctor regularly to check the liver function test to detect evidence of inflammation
7. this doctor should also calculate your father’s Fibrosis Score every 2 years. If it is abnormal, your father should see a liver internist. This Fibrosis Score calculator is easily available in the internet

I hope you find my answers helpful.

Yu Ting answered 2 years ago

My sister has type 1 autoimmune hepatitis. She has problems with her menstruation, sometimes she skips the cycles. Should we also see an obgyn, or is it a symptom of her condition that will automatically get better as we treat it?

Dr Ho Choon Kiat replied 2 years ago

The safest way forward is to consult the proper expert, which is the ObsGyn, rather than assume that this is due to the underlying autoimmune hepatitis. It may even be a consequence of the treatment she is receiving for her liver problem. Or it may be an entirely separate issue. So seek help from the ObsGyn to get a proper diagnosis.

Edwin answered 2 years ago

How serious is a liver abscess? Would a surgical drainage cure it for good?

Dr Ho Choon Kiat replied 2 years ago

A liver abscess is a serious infection. It can lead to other complications including septicemia. However, most liver abscess can be treated with antibiotics alone. This is especially true for small abscesses, particularly those less than 5cm in diameter. If they are large or do not respond to antibiotics, then drainage may be needed. This is either done by sticking a drain in (percutaneous drainage) or by surgery. We usually would prefer the percutaneous approach as it is minimally invasive. Of course some abscesses are better drained by surgery. You would have to consult your surgeon.

But as for your question if surgical drainage can cure it “for good”. Firstly, any treatment cannot be 100% sure in outcome. But I would say that the doctor has to choose the appropriate treatment based on the patient’s condition and the characteristics of the abscess to achieve the best outcome.

Secondly, if by your question, what you meant was that the disease will not come back again if surgical drainage was done – that is not true. Sometimes there may be an underlying condition that makes a person more prone to recurrent liver abscesses. The surgeon has to do a thorough evaluation of the patient to look for such conditions, e.g. poorly controlled diabetes

Mohammad Sallehin answered 2 years ago

My upper right abdomen is swollen and painful. My skin also itches and around the area there are black spots appearing on my skin. These symptoms come with dry mouth. I feel like my appetite has been affected too. Are these symptoms of a liver problem? What checkups would you suggest I do?

Dr Ho Choon Kiat replied 2 years ago

Thank you for your question. It is reasonable for you to suspect a liver issue as liver problems can present as pain in the right upper abdomen. However, other organs can also present as pain in that region, such as gallbladder or colon problems. Itchiness of skin can sometimes occur with liver problems but black spots are not typical. The easiest way to know if you have a liver problem will be to get your blood tested under a panel called “Liver Function Test”. Depending on the results, the doctor can then advise you on what is the next thing to do.

Martin answered 2 years ago

My wife often complains about nausea and gas in her stomach. Sometimes after eating, she vomits. And over the weekend I noticed that her nails turned yellow. How could we check if it is a liver problem?

Dr Ho Choon Kiat replied 2 years ago

The easiest way is to consult a doctor and get a blood test called the “Liver Function Test”. As your wife’s symptoms appear to occur after she eats, one of the things to consider is gallstones. Your doctor will analyse your wife’s blood test result and then recommend further tests as required. If he suspects gallstones, he would get an ultrasound for your wife. If your wife’s liver function test turns out to be normal, then perhaps she may need a gastroscopy to make sure this is not a gastric problem.

Tony Wee answered 2 years ago

I was diagnosed with fatty liver. But I don’t drink alcohol. How could this be?

Dr Ho Choon Kiat replied 2 years ago

This is definitely possible. In fact, Non-Alcoholic Fatty Liver Disease, or NAFLD for short, is becoming the more common form of fatty liver we see in our practise. The underlying causes leading to NAFLD relates frequently to lifestyle issues, such as lack of exercise, food rich in fats and carbohydrates, obesity, etc. Diabetes can also accelerate the liver damage caused by NAFLD. And all these can occur in non-alcoholics.

Michelle answered 2 years ago

My right abdomen is bloated. When I touch it, I can feel it’s a bit swollen. I also have diarrhea and nausea. When I take caffeine, whether it’s from coffee or tea, I get a fever for a few hours, and I feel very weak and can’t move. What is the best examination and treatment for my condition?

Dr Ho Choon Kiat replied 2 years ago

Thank you for your email. Your symptoms are quite perplexing, particularly the onset of fever after taking caffeine. This is not specific for any particular disease. I would, however, use the right sided abdominal bloating as my start point, which you mentioned, is associated with diarrhoea and nausea. Possible problems include liver problems, gallbladder problems and intestinal (colon or small bowel) problems. A good test to look at all 3 organs to ensure no dangerous problems would be an abdominal scan, particularly a CT scan. The doctor may also add on some blood test to guide him in getting a diagnosis. Treatment comes after we have an idea what we are dealing with.

Timothy answered 2 years ago

I’ve heard that jaundice is a sign of liver disease. My wife’s fingers and eyes have been slightly yellowish for the past two days. While there is no pain or changes in her bowel movements or urine, I am still worried. She has a slight fever also. Should we be worried and does she need to undergo any tests?

Dr Ho Choon Kiat replied 2 years ago

Broadly speaking, jaundice does point to a liver problem, but not all the time. Even if it is arising from a liver problem, it can either be an issue with the liver cells, eg hepatitis, or bile ducts, eg bile duct blockage from gallstone. If the white of the eye turns yellow, that is a sign of jaundice. However, fingers looking yellow is less specific. The easiest way to check if your wife has jaundice is to check her blood bilirubin level. Hope my reply helps.

Dexon answered 2 years ago

Is a liver transplant the only effective way to treat cirrhosis? Are there other options that can be explored?

Dr Ho Choon Kiat replied 2 years ago

Cirrhosis is the hardening of the liver. This will lead to eventual worsening of the liver function and even liver failure. Once there is cirrhosis, it is not reversible. However, that does not mean that the liver will fail. It depends on the degree of cirrhosis. For the early stage, the liver function may still be intact. In such cases, it is important to control the disease causing the liver cirrhosis. For example, if the cirrhosis is due to hepatitis B, the person may need to start anti-viral medications to suppress the Hepatitis B virus. Liver transplant is needed if the liver cirrhosis leads to liver function impairment.

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