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 scarred tissue or fibrous tissue formation. This exaggerated wound healing response interferes with normal liver function.
Stages of Liver Fibrosis
There are various grading systems developed for liver fibrosis staging that determine the degree of damage afflicted to the liver and the progression of liver fibrosis. These include Metavir, Batts and Ludwig, and International Association for Study of the Liver (IASL).
Metavir Staging ranges from F0 to F4 with F0 having no fibrosis, F1 showing periportal fibrotic expansion, F2 showing periportal septae (more than 1 septa) formation, F3 showing portal central septae formation and F4 showing cirrhosis.
Batts and Ludwig scoring system include F0 having no fibrosis, F1 having fibrous portal expansion, F2 having rare bridges or septae formation, F3 having numerous bridges or septae formation and F4 having cirrhosis.
International Association for Study of the Liver (IASL) scoring system include F0 with no fibrosis, F1 with mild fibrosis, F2 with moderate fibrosis, F3 with severe fibrosis and F4 with cirrhosis.
The advanced stage of liver fibrosis is cirrhosis of liver.
What is Advanced Fibrosis of the Liver?
Liver cirrhosis is a chronic progression of fibrosis (scarring) of healthy liver tissue leading to functional deterioration of liver. Liver is supposed to have over 500 functions including protein synthesis, destruction of old RBCs, detoxification and metabolism of chemicals and drugs along with hormone regulation and digestion of fats assisted by the production of bile, to name a few. Liver cirrhosis is caused by chronic liver damage caused by various conditions or diseases.
Symptoms and Causes of Liver Cirrhosis
Generally, cirrhosis in the initial stages is asymptomatic. The signs and symptoms when present include weakness, lethargy, easy bruising and bleeding, pruritis, jaundice, ascites, nausea, vomiting, weight loss, loss of appetite, swelling of legs, enlarged veins in the esophagus and upper abdomen, confusion, and excessive sleepiness/drowsiness and coma.
There are various causes of liver cirrhosis, but the most common causes include chronic alcoholism, chronic viral disease (hepatitis B and C, HIV) and/or fatty liver. Other causes of liver cirrhosis may include hemochromatosis, Wilson’s disease, cystic fibrosis, biliary atresia, glycogen storage disease, Alagille syndrome, autoimmune hepatitis, primary biliary cirrhosis, infection (schistosomiasis), primary sclerosing cholangitis, and/or medications such as methotrexate.
Complications of Cirrhosis
The most common cause of liver cirrhosis are chronic alcoholism and chronic viral diseases, so it is best to stay healthy by eating hygienic/healthy food, immunizations and moderation of alcohol. Liver cirrhosis can have drastic effect on blood flow through the body and can lead to portal hypertension along with functional deterioration. It can lead to swelling in the abdomen and legs causing edema of legs and ascites, splenomegaly and easy bleeding. Other complications may include infections in the body, increased chances of liver cancer, malnutrition, bone disease, hepatic encephalopathy, diabetes, and acute on chronic liver failure. The inability of diseased liver to metabolize various medications may lead to toxicity.
Prevention of Cirrhosis
Liver cirrhosis can be prevented by eating a healthy diet, which is rich in fruits and vegetables, avoiding fats and maintaining a healthy weight in individuals who are overweight and obese, reducing hepatitis risk by proper precautions, immunizations, and moderation of alcohol.
Liver cirrhosis is one of the leading causes of death in the US and chronic hepatitis C infection and chronic alcoholism are the two main leading causes of cirrhosis. Initially, both individuals suffering from hepatitis C infection and chronic alcoholism are not aware of liver damage as they are asymptomatic in the early stages. Cirrhosis is a slow progressing disease and usually takes years to develop. The development of cirrhosis differs from person to person and depends on various factors such as genetics, individual metabolism, food habits, other health conditions and cause of the disease.
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