Liver fibrosis occurs when the healthy tissue of your liver becomes scarred and therefore cannot work as well. Fibrosis is the first stage of liver scarring. Later, if more of the liver becomes scarred, it’s known as liver cirrhosis.
Doctors don’t often diagnose liver fibrosis in its mild to moderate stages. This is because liver fibrosis doesn’t usually cause symptoms until more of the liver is damaged.
When a person does progress in their liver disease, they may experience symptoms that include:
- appetite loss
- difficulty thinking clearly
- fluid buildup in the legs or stomach
- jaundice (where the skin and eyes appear yellow)
- unexplained weight loss
Liver fibrosis occurs after a person experiences injury or inflammation in the liver. The liver’s cells stimulate wound healing. During this wound healing, excess proteins such as collagen and glycoproteins build up in the liver. Eventually, after many instances of repair, the liver cells (known as hepatocytes) can no longer repair themselves. The excess proteins form scar tissue or fibrosis.
Several types of liver diseases exist that can cause fibrosis. These include:
- autoimmune hepatitis
- biliary obstruction
- iron overload
- nonalcoholic fatty liver disease, which includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH)
- viral hepatitis B and C
- alcoholic liver disease
Treatment options for liver fibrosis usually depend upon the underlying cause of the fibrosis. A doctor will treat the underlying illness, if possible, to reduce the effects of liver disease. For example, if a person drinks alcohol excessively, a doctor may recommend a treatment program to help them stop drinking. If a person has NAFLD, a doctor may recommend making dietary changes to lose weight and taking medications to promote better blood sugar control. Exercising and losing weight may also help to reduce the disease’s progression.
A doctor may also prescribe medications known as antifibrotics, which have been shown to reduce the likelihood that liver scarring will occur. The antifibrotic prescribed usually depends on the underlying medical condition. Examples of these treatments include:
- chronic liver disease: ACE inhibitors, such as benazepril, Lisinopril, and ramipril
- hepatitis C virus: a-Tocopherol or interferon-alpha
- nonalcoholic steatohepatitis: PPAR-alpha agonist
While researchers are conducting many tests to try to find medications that can reverse the effects of liver fibrosis, there aren’t any medications that can accomplish this currently.
If a person’s liver fibrosis advances to where their liver is very scarred and doesn’t work, a person’s only treatment is often to receive a liver transplant. However, the waiting list is long for these transplant types and not every person is a surgical candidate.
Traditionally, doctors considered taking a liver biopsy the “gold standard” of testing for liver fibrosis. This is a surgical procedure where a doctor would take a tissue sample. A specialist known as a pathologist will examine the tissue for the presence of scarring or fibrosis.
Another option is an imaging test known as transient elastography. This is a test that measures how stiff the liver is. When a person has liver fibrosis, the scarred cells make the liver stiffer. This test uses low-frequency sound waves to measure how stiff liver tissue is. However, it’s possible to have false positives where the liver tissue may appear stiff, but a biopsy doesn’t show liver scarring.
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