How Liver Fibrosis Develops and Is Treated
Medically reviewed by Jay N. Yepuri, MDMedically reviewed by Jay N. Yepuri, MDLiver fibrosis is scarring of the liver. It has many causes, including alcohol-induced damage, infections, and diseases that harm the liver. Inflammation and injury of the liver can lead to scarring, with symptoms such as nausea, vomiting, fatigue, confusion, and enlargement of the abdomen.Treatment for liver fibrosis may involve managing the underlying cause. There sometimes is a need for a liver transplant. When treatment is started at an early stage, these therapies can be effective and may reverse the damage and relieve symptoms.
Photo composite by Michela Buttignol for Verywell Health; Getty Images
Liver Fibrosis FormationLiver fibrosis worsens over time, and the severity of damage is divided into stages. The symptoms might not develop until later stages, but diagnostic testing can often detect signs of early liver damage.Stages For most people, liver fibrosis is expected to worsen if it is not treated. Fibrosis progresses as more areas of the liver are injured and form scars. The stages of liver fibrosis are:F0: No fibrosisF1: Mild fibrosis, with a few small areas of scar tissueF2: Moderate fibrosis, with thickening scar tissueF3: Severe fibrosis, with new vessels forming in the liver F4: Liver cirrhosis, with extensive scarring throughout the liver and impaired liver function
Related: Hepatitis and Cirrhosis Similarities and Differences
Causes and Risk FactorsFibrosis develops due to inflammation and damage, leading to thickened fibrous and collagen scars as the body attempts to heal from the injury. Damage in different areas of the body can lead to fibrosis in those areas. Liver fibrosis is due to damage in the liver.Common causes of liver fibrosis include:Chronic alcohol-induced damage: Alcohol causes liver damage. Recurrent use of and high amounts of alcohol for many years results in fibrosis.Hepatitis A: Spread from contaminated food and water, hepatitis A usually causes a mild illness but can cause severe life-threatening illness. It rarely leads to fibrosis. Hepatitis B, hepatitis C, and hepatitis D: These viruses target the liver and are spread through sexual transmission or from blood (such as intravenous drug needles).Metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic dysfunction-associated steatohepatitis (MASH): These diseases are characterized by fat accumulation in the liver. Risk factors include obesity, diabetes, high cholesterol, and genetic predisposition.Other infections: Some infectious organisms that do not typically target the liver, such as Escherichia coli (E. coli), streptococcus, tuberculosis, and others, can sometimes affect the liver, potentially causing liver fibrosis.Schistosomiasis: This parasitic infection spreads in contaminated water in tropical climates. It can cause long-term liver disease that leads to liver fibrosis. This parasite is much less common than it used to be due to the implementation of improved sanitation and disease control.Wilson’s disease: This disorder is caused by a genetic trait affecting how the body handles copper.Your liver cannot do its job if the cells are injured. Additionally, scar tissue interferes with blood flow throughout the liver. Both of these problems lead to the symptoms of liver fibrosis.Is It Reversible?Sometimes liver fibrosis is reversible if it is diagnosed and treated in an early stage. When liver disease advances to late stages, or when cirrhosis begins, the damage is often not reversible.
What Does the Liver Do? Your liver interacts with almost every other organ and system in your body. A few of the functions of the liver include releasing enzymes to help your body absorb nutrients from the food you eat, detoxifying chemical byproducts of medications after they have had their action, and helping balance hormones in your body.
SymptomsUsually, liver fibrosis does not cause symptoms until significant liver damage has occurred.Symptoms can include:Abdominal distention (enlarged abdomen) ConfusionFeeling weakJaundice (yellowing of the skin and eyes due to a buildup of the substance bilirubin in the blood)Loss of appetiteNauseaTirednessVomitingWeight gain due to ascites (fluid in the abdomen)Since your liver helps you absorb nutrients from the food you eat, many of these symptoms are caused by malnutrition. Additionally, because your liver helps your body detoxify chemicals, some of the symptoms are caused by the buildup of harmful chemicals in your body.Complications of advanced liver fibrosis can include:Ascites is a buildup of fluid in the abdomen. It can cause pressure on your lungs or other organs, causing pain and shortness of breath.Bleeding varices can cause vomiting, low blood pressure, dizziness, and loss of consciousness—and can be fatal.Esophageal varices is enlargement of blood vessels in the esophagus that develops as a result of obstructed blood flow in the liver.Hepatic encephalopathy is confusion and behavioral changes caused by toxins accumulating in the brain.Hepatic (liver) cancer may develop as the repeated injury and healing of liver cells results in cancer-inducing alterations. Liver decompensation describes a rapid decline in liver function that can occur when the liver can’t function after it had previously been able to function with moderate damage.Testing to Diagnose Liver FibrosisTests can detect decreased liver function and liver fibrosis.Diagnostic tests for liver fibrosis include:Abdominal imaging: Imaging tests, such as computed tomography (CT), can identify an abnormal appearance of the liver.Biopsy: A sample of liver tissue is removed and examined with a microscope to identify the type and severity of liver damage.Copper level: Elevated copper in the blood or urine can indicate Wilson’s disease.Hepatitis tests: Blood tests can detect evidence of viral hepatitis by identifying the virus or the immune proteins (antibodies) that fight a specific virus.Liver function tests: Liver function blood tests include measures of different enzymes and proteins that can be altered due to liver failure.Treatment Based on Stage If you have liver fibrosis, your treatment would be based on the stage, as well as the cause of your liver disease. Treatments for infectious causes may include antiviral medication, antibiotics, or antiparasitic therapy that’s targeted to the specific cause of your liver infection.Sometimes, anti-inflammatory therapy may also be used to reduce inflammation that’s associated with the infection. Since anti-inflammatory medications can lower your immune system function, potentially worsening an infection, you would need close monitoring of your infection. Additionally, certain complications, such as varices or ascites, may require intervention with surgical procedures.
Learn More: What to Expect From a Liver Transplant
Liver Transplant QualificationA liver transplant can be an option for some people who have liver disease. During this operation, you would have removal of cancer tissue from your liver, and you could have your whole liver removed. You would receive a healthy donor liver. This procedure is complicated and involves surgical connections between blood vessels, so your liver can have adequate blood flow.You might qualify for a liver transplant if your healthcare providers anticipate that you would be able to survive the complicated procedure and that having a new liver would improve your chances of having a healthy life. Prognosis and Symptom Management The outcome of liver fibrosis can vary. With early treatment, you might have many years of survival. Your prognosis is dependent on several factors, including:Complications: Survival and anticipated outcome would be better if you haven’t developed serious complications, such as bleeding esophageal varices.Stage of diagnosis and treatment: Earlier-stage liver disease has a better outcome than late-stage disease.Underlying health conditions: If you do not have other health problems like heart disease or immune disease, you will have a greater chance of successful treatment.Summary Liver fibrosis is scarring of the liver. Many, different liver infections and diseases can damage the liver, leading to inflammation and scarring. If you are diagnosed at an early stage with a treatable liver disease, treatment can help improve your outcome and can often be curative.Your therapy would be guided by the cause of your liver disease, which stage you are in, and any complications you are experiencing. Sometimes, a liver transplant can help improve the outcome of liver fibrosis. Read the original article on Verywell Health.
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