Is Liver Fibrosis Cancer?
Fibrosis is a vital constituent of chronic liver diseases, which ultimately can cause complications such as cirrhosis.
Chronic liver diseases, regardless of their cause (chronic B or C virus infection, alcohol abuse, metabolic disorders such as hemochromatosis, congenital alpha-1 antitrypsin deficiency, autoimmunity, drugs, etc.) with an inflammatory process for a certain time produce a progressive increase of collagen fibers in the hepatic parenchyma called fibrosis, whose final stage is hepatic cirrhosis.
The progression of hepatic fibrosis alters the normal structure of the liver, which involve disorders in its circulation with augmented portal pressure, which is the pressure of blood in the portal territory (abdominal veins). When this increase reaches an important level it leads to the advent of esophageal varices, water retention, with edema in the lower limbs and ascites (accumulation of fluid in the abdomen).
Liver fibrosis is the result of gathering of fibrous and rigid scars in liver. In order to reach hepatic fibrosis, a succession of events with the inflammatory process of the hepatic cell is necessary due to the aforementioned. This inflammatory process result in hepatocytes (functional cells of the liver) to suffer damage or die; then the immune system gets triggered to carry on with the process of repair. The injury or necrosis of hepatocytes promotes production of cytokines and other chemicals by immune system.
The cytokines stimulate the functioning of stellate hepatocytes, which are support cells located in liver, which along with other cell types start to produce collagen, fibronectin, and proteoglycans. All of these substances tend to restaurate the damaged sectors by the death of the affected liver cells.
All these elements are stored in liver resulting in accumulation of extracellular matrix. Simultaneously, the process of dissolution of collagen gets affected.
In healthy tissues, there exists a balance between the synthesis (fibrogenesis) and the degradation (fibrolysis) of the matrix tissue. Fibrosis develops when balance is disturbed, that is, when tissue accumulates faster than it is degraded and eliminated by the liver.
As time passes by the inflammatory process continue, the accumulation of the collagen material inside the liver arises, which causes fibrosis. In some diseases this is very slow and has stopped many years to reach the final stage of cirrhosis.
Liver fibrosis is not developed at the same pace in all patients and in fact in some people with hepatitis C or B it remains more or less stable throughout. There are many factors that influence the progression of fibrosis: for example, the process advances faster in males than females, and also people above the age of 60.
In addition, it has been demonstrated that depression of the immune system – for instance, due to conditions like HIV or taking immunosuppressive medications after an extensive procedure like a liver transplant – also exacerbates fibrosis. Alcohol abuse is beyond doubt related to an aggravation of both cirrhosis as well as fibrosis. Several studies indicate that steatosis and insulin resistance also are linked to a faster progression and a more advanced degree of fibrosis.
In the first stages, the liver works to some extent well and not many people have any symptoms. But with continuous inflammation and spread of lesions, the scar tissue begins to accumulate that connects with the existing scars, which leads to an alteration of liver’s metabolic functions.
As the disease advances, cirrhosis develops where the liver is filled with scars that restrict the blood flow and impede the adequate functioning of the liver.
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