Liver fibrosis is the excessive scarring of liver tissue, which is due to progressive liver inflammation and liver cell death in chronic liver diseases. Liver fibrosis occurs when liver tries to repair its damaged cells through deposition of new collagen fibers. This deposition of repaired tissue results in fibrous tissue formation. This exaggerated wound healing response interferes with normal liver function.
Causes of Liver Fibrosis
Liver fibrosis occurs due to repeated damage caused either by various drugs or by disorders. The hepatocytes are injured due to trauma, excess alcohol consumption, toxins, hepatitis B, hepatitis C, biliary obstruction, autoimmune hepatitis, non-alcoholic fatty liver disease, and Wilson’s disease. However very rarely liver fibrosis the primary problem, mostly it is secondary other liver diseases.
The stages determine the degree of damage to the liver. The activity or the prediction of how fibrosis is progressing is done based on a popular scoring system called the METAVIR scoring system.
The fibrosis stages range from F0 to F4. F0 staging depicts no evidence of fibrosis, F1 stage depicts portal fibrosis without any septa formation, F2 stage depicts portal fibrosis with few septa formation, F3 stage shows various septa, but without any cirrhosis, F4 stage depicts liver fibrosis. The most severe form of liver fibrosis includes F3 and F4 stages.
Symptoms of Liver Fibrosis
In general, liver fibrosis is not diagnosed in the initial stages, as the symptoms do not occur until the liver damage has progressed to advanced stages. The symptoms include fatigue, lethargy, loss of appetite, nausea, vomiting, jaundice, mental confusion, accumulation of fluid in the legs and stomach. Mostly the symptoms are those of liver cirrhosis. The brain function deteriorates due to inability of the damaged liver cells to filter toxic substances from the blood, which in turn build up in the blood and reach the brain.
How is Liver Fibrosis Diagnosed?
It is difficult to diagnose liver fibrosis in the early stages, as there are no clear symptoms in the beginning. The diagnosis is possible only in the later stages when the destruction of liver progresses and symptoms start occurring. The doctor starts by taking history of symptoms, which is followed by a physical examination. Further, the doctor will order blood tests in order to evaluate the function of liver, along with tests of liver enzymes (ALT and AST) to assess their level. The LFTs will be abnormal in the presence of liver fibrosis.
Imaging Tests of Liver Are:
Abdominal Ultrasound that uses sound waves to produce images shows the size and shape of the liver. It also shows the blood flow through liver. The liver with sclerosis will look lumpy and shrunken on an ultrasound image.
CT scan of abdomen uses special X-ray imaging technology to produce multiple pictures of the inside of the abdomen. The fibrosed liver will look lumpy and shrunken on CT scan.
MRI Scan produces detailed images of the liver by using magnetic field. It is highly sensitive, can detect even small changes, and can calculate the fat percentage in liver.
Ultrasound Elastography is specifically used to detect liver fibrosis. It shows elasticity (stiffness) in the liver; fibrotic liver is stiffer than a normal one.
MR Elastography (MRE) is a special non-invasive technique as it gives detailed study of the liver and if used earlier, further the need of liver biopsy is ruled out. It can detect liver elasticity (stiffness) far more early than other imaging techniques.
Liver Biopsy is the collection of a small sample of liver tissue using fine needle aspiration, laparoscopic biopsy or surgical/excisional biopsy. The sample is further sent pathologic examination.
Treatment of Liver Fibrosis
The treatment of liver fibrosis is mainly symptomatic, with the aim of delaying the progression of the disease. With proper care and treatment, liver fibrosis can be reversed in its initial stages as well as its progress can be slowed down.
Cessation of alcohol, dietary changes, corticosteroid therapy, antivirals and anti-inflammatory drugs are used in the management of liver fibrosis.