Liver Fibrosis It is the deposition of excessive and abnormal Collagen in the liver as a result of long term liver injury / Repeated liver Infection or inflammation.
Associated Anatomy of Liver Fibrosis
The liver – Diagram
Causes of Liver Fibrosis
Almost every chronic liver condition has the potential to cause liver fibrosis. The most common are:
Nonalcoholic fatty liver disease
Hepatitis C or hepatitis B may cause liver fibrosis if the conditions are recurrent or chronic.
Alcoholic fatty liver disease occurs because of excessive intake of alcohol over a prolonged duration.
Use of certain medicines like methyldopa, chlorpromazine, or methotrexate may result in liver fibrosis.
Liver Fibrosis Epidemiology
- The incidence of liver fibrosis is growing because of alcohol abuse and growth in the obese population.
- 2.8 % of people above the age of 40 years may have mild to moderate liver fibrosis.
- The prevalence of NAFLD is higher than AFLD.
Natural Progression of Liver Fibrosis
In the absence of treatment, liver fibrosis progresses and involves more areas having dead tissues and scarring. Failure to address the risk factors can impact the functioning of the liver. The permanent damage to the liver leads to liver failure, liver cirrhosis, and coma.
Pathophysiology of Liver Fibrosis
In the liver, the healing mechanism results in continuous accumulation of the extracellular matrix because of tissue damage. Circulating fibrocytes may encourage the development of liver fibrosis. Remodeling of fibrous tissue enables them to produce collagen. The process of liver fibrosis is a dynamic accumulation of scar tissues that can rapidly progress or reverse.
Possible Complications of Liver Fibrosis
Liver cirrhosis is the most vital and severe complication of liver fibrosis. Extensive scarring of liver tissues can lead to irreversible liver damage and loss of liver function. Impairment of the liver leads to accumulation of fluid in the abdomen and buildup of toxic waste that impacts the brain. The condition is known as hepatic encephalopathy. The process of liver fibrosis can continue for years or even decades, causing severe and irreversible damage to the liver.
Symptoms of Liver Fibrosis
The condition of liver fibrosis may not result in any symptoms. Most symptoms are due to decreased liver functions.
- Loss of appetite - Impairment of liver function can lead to a decline in appetite.
- Jaundice - Yellowing of the skin and the eyes caused by elevated bilirubin levels is another frequent cause.
- Loss of weight - One may lose weight for no perceptible reasons.
- Nausea - The individual may experience nausea as a common symptom.
- Generalized weakness - Weakness and lethargy are common symptoms of liver disorders.
Possible treatment for Liver Fibrosis
The treatment of liver fibrosis aims at preventing further scarring by treating the possible causes.
- Ceasing alcohol intake - Avoidance of alcohol is crucial in the treatment of alcoholic liver disease.
- Weight management - Reducing one’s weight and maintaining a healthy lipid profile helps manage the nonalcoholic fatty liver disease.
- Avoiding medicines - Stop the medication that is responsible for liver fibrosis
- Bile duct repair- Removal of blockages in the bile ducts like biliary stones
- Removal of heavy metals -Treatment of copper or iron overload by using specific chelating agents
Risk Factors of Liver Fibrosis
- Alcohol abuse - Excessive consumption of alcohol can seriously damage the liver and cause liver fibrosis.
- Use of certain medications - Methotrexate, steroids, and methyldopa are some medicines that may damage the liver.
- Chronic liver diseases - Conditions like Hepatitis C may cause liver fibrosis.
- Genetic conditions - Presence of Wilson disease, deficiency of alpha-1-antitrypsin, or hemochromatosis can cause scarring of the liver.
- Metabolic syndrome - High blood sugar levels, obesity around the middle, and excess triglyceride or cholesterol levels can indicate metabolic syndrome and increase the risk of liver cirrhosis.
Stages of Liver Fibrosis
Physicians use the METAVIR staging system to understand the extent of scarring in liver fibrosis.
- Stage F0 - The preliminary stage involves inflammation of the liver with no scarring or fibrosis.
- Stage F1 - Vital aspects of Stage F1 or Portal Fibrosis are the presence of mild scarring with the death of liver tissues in a few areas of the liver. There is no impact on the structure or functioning of the liver.
- Stage F2 - Stage F2 of Periportal Fibrosis involves growth in areas of dead liver tissues and liver function impairment.
- Stage F3 - Extensive scarring and tissue death are signs of Bridging Fibrosis in Stage F3.
- Stage F4 - The final stage, or Stage F4, is cirrhosis of the liver. The damage to the liver is permanent, and there is a complete loss of liver function.
Typical Test of Liver Fibrosis
Blood tests like Liver Function Tests may provide information about a liver disorder. Fibro scan, Magnetic resonance imaging (MRI), CT imaging, and ultrasound tests help establish the reasons for the malfunctioning of the liver. Liver biopsy detects liver fibrosis through surgical removal of liver tissue for microscopic examination.
Primary Prevention of Liver Fibrosis
- Minimize the chances of hepatitis infection. Explore the option of hepatitis vaccination.
- Treating the underlying cause like a chronic liver disease that may lead to liver fibrosis
- Restrict or avoid the use of medicines that can damage the liver.
- Maintain normal blood pressure and blood sugar levels by performing regular exercises and using appropriate medication.
- Reduce weight to lower the risk of liver fibrosis.
- Stop or limit alcohol intake.
Secondary Prevention of Liver Fibrosis
- Strictly no alcohol intake
- Eating a healthy diet
- Following strict exercise and diet regimen to maintain a healthy body weight
- Periodic blood and imaging tests
- Reduce fat intake
- Staying active to prevent buildup of fat
- Following the medication dosage to treat underlying causes of liver fibrosis
- Removal of the obstruction that may be blocking bile ducts
Alternate name
Hepatic fibrosis
Expected Prognosis of Liver Fibrosis
The detection of liver fibrosis in its early stage is necessary for a better outcome. It is possible to slow down or even reverse the disease progression in the initial stages. There is a likelihood of irreversible damage to the liver and cirrhosis if the liver fibrosis reaches an advanced stage.
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