Liver Fibrosis: Symptoms, Stages, Causes, Test, Treatment

Liver fibrosis is a medical condition characterised by the excessive accumulation of collagen and other proteins in the liver. It occurs in response to chronic liver injury or inflammation caused by fatty liver or hepatitis. This leads to the progressive scarring of liver tissue. Nearly all types of chronic liver disease can cause fibrosis over time.

Liver fibrosis progresses through several stages, each indicating the extent of scarring and damage to the liver. These stages are typically assessed using the METAVIR scoring system based on inflammation (activity) and damage (fibrosis).

The activity grades are as follows: 

1. A0: No activity 

2. A1: Mild activity 

3. A2: Moderate activity

4. A3: Severe activity 

The level of fibrosis can have the following stages: 

1. F0: No fibrosis 

2. F1: Portal fibrosis without the formation of septa (scar tissue bridges)

3. F2: Portal fibrosis with the formation of few septa 

4. F3: Numerous septa but without cirrhosis 

5. F4: Cirrhosis 

A lower score suggests minimal inflammation and liver damage, whereas a higher score indicates more. For example, an individual with the most advanced stage of the disease could have a METAVIR score of A3 and F4. This highlights significant inflammation and cirrhosis.

The liver fibrosis stages can also be determined using the Batts and Ludwig scoring system. It measures fibrosis from grade 1 to grade 4, with grade 4 representing the highest severity.

According to a study by Prof Pere Gines et al. in 2016, 6-7% of the adult global population have liver fibrosis and are unaware of it. This is because the condition often does not show symptoms in its early stages.

Liver fibrosis symptoms are usually experienced by individuals when the condition progresses to cirrhosis. The most common symptoms of early cirrhosis are as follows: 

1. Reduced appetite 

2. Weakness 

3. Nausea and vomiting

4. Unexplained fatigue 

5. Weight loss without a clear cause 

6. Mild discomfort or pain in the upper right abdomen 

As cirrhosis becomes more advanced, patients may experience the following symptoms: 

1. Easy bruising or bleeding 

2. Swelling in the lower legs or ankles due to fluid retention 

3. Jaundice (yellowing of the skin and eyes)

4. Ascites (Abdominal swelling from fluid accumulation)

5. Intense skin itchiness

6. Dark-coloured urine 

7. Difficulties with memory, concentration, or sleep

Liver fibrosis develops when the liver repeatedly undergoes injury or inflammation. This prompts the liver cells, called hepatocytes, to initiate wound healing. In this process, proteins like collagen and glycoproteins accumulate excessively in the liver. 

Over time, with repeated damage and repair, the liver cells lose their ability to regenerate. This leads to scar tissue formation, known as fibrosis, from the buildup of excess proteins. 

Liver Fibrosis Risk Factors

Liver fibrosis can be triggered by several factors. Understanding these will help prevent or slow the progression of fibrosis. Some key risk factors include:

Modifiable Risk Factors

Individuals can influence these risk factors through lifestyle changes or medical interventions. Addressing the following can significantly reduce the risk of developing liver fibrosis: 

1. Excessive Alcohol Consumption: Regular, heavy drinking can severely damage liver cells, leading to fibrosis.

2. Non-alcoholic Fatty Liver Disease (NAFLD): A condition in which fat accumulates in the liver. It often results from obesity and insulin resistance, which can progress to fibrosis. Around 9% to 25% of people with non-alcoholic steatohepatitis or NASH (the most severe form of NAFLD) progress to cirrhosis over a 10 to 20-year period.

3. Certain Medications: Prolonged exposure to specific drugs, like anabolic steroids and over-the-counter painkillers containing acetaminophen, can harm the liver.

Non-Modifiable Risk Factors

These are inherent and cannot be changed by personal actions. Awareness of the following factors is important for early detection and management.

1. Chronic Hepatitis Infections: Long-term infections with hepatitis B and C viruses are the primary causes of liver damage. They contribute significantly to fibrosis development.

2. Autoimmune Hepatitis: In this disorder, the immune system attacks liver cells. This can cause fibrosis.

3. Genetic Conditions: Congenital disorders like haemochromatosis and Wilson’s disease can damage liver tissue. These involve abnormal accumulation of iron and copper in the liver, respectively. 

Preventing liver fibrosis is essential for maintaining a healthy liver and overall well-being. Individuals can take proactive steps to protect their liver from fibrosis by identifying the various factors contributing to liver damage. The recommended key prevention strategies to consider are:

1. Avoiding Alcohol: Limiting or abstaining from alcohol reduces the risk of liver damage and fibrosis.

2. Maintaining a Healthy Weight: Obesity is a significant risk factor for liver fibrosis, particularly due to NAFLD. A well-balanced diet and regular exercise can help manage weight and reduce fat accumulation in the liver.

3. Managing Chronic Conditions: Proper control of high blood pressure, diabetes, and chronic hepatitis B and C can reduce the risk of liver fibrosis.

4. Vaccination: Getting vaccinated against hepatitis B can help prevent the condition, a potential cause of liver fibrosis.

5. Avoiding Certain Medications: Be cautious when using supplements and over-the-counter drugs that may harm the liver. Always consult a doctor before starting any new medication.

Diagnosing fibrosis is an important step in managing liver health. Several examinations are used to assess the extent of the condition and guide treatment decisions. Some of the common liver fibrosis tests are as follows: 

1. Medical History and Physical Examination: The medical specialist will ask about symptoms, alcohol consumption, and history of hepatitis or liver disease. They may also look for physical signs like jaundice and abdominal or leg swelling. 

2. Blood Tests: These include tests for liver enzymes, bilirubin, and viral hepatitis. 

3. Imaging Studies: Techniques like ultrasound, MRI (Magnetic Resonance Imaging), and CT (Computed Tomography) scans can visualise the size, shape, and texture of the liver. 

4. FibroScan: Also known as transient elastography, it is an advanced, noninvasive liver fibrosis scan that measures liver stiffness. Normal results lie between 2 and 7 kilopascals (kPa). Results higher than this may indicate a liver disease.

5. Liver Biopsy: Traditionally, it was considered a gold standard for diagnosing liver fibrosis. The technique involves removing a small liver tissue sample with a needle for microscopic examination. It can provide information about the degree of fibrosis. 

Note: Tests prescribed can vary from one patient to another based on their condition. 

How to prepare for the doctor’s consultation? 

Preparing for a consultation about liver fibrosis involves gathering relevant health information and formulating questions to understand the condition better. Here’s how to get ready:

1. Compile Medical History: List any previous diagnoses, surgeries, medications, supplements, and family history of liver disease. Include any relevant lifestyle factors like alcohol consumption.

2. Document Symptoms: Patients should note down any symptoms they have experienced, even if they seem unrelated. These include changes in appetite, fatigue, weight loss, or jaundice.

Questions to Ask the Doctor 

Asking questions during the consultation can help patients understand their condition better and clarify their treatment options. Consider asking the following questions:

1. Is liver fibrosis curable?

2. What stage is my liver fibrosis, and what does it mean? 

3. What treatment options are available for my condition? 

4. Will I need medication, and if so, what are the possible side effects?

5. Can liver fibrosis progress to cirrhosis or liver failure?

Patients should not hesitate to ask any additional questions they may have.

When detected early, liver fibrosis can be reversed. In other cases, liver fibrosis treatment focuses on managing the underlying cause to prevent further damage and progression. The treatment options are as follows: 

Nonsurgical Options

These primarily focus on managing the root causes and symptoms through lifestyle changes and medication.

1. Home Remedies: In certain situations, the following natural remedies may reduce fibrosis: 

1. Ensuring adequate hydration 

2. Consuming a moderate amount of coffee

3. Using milk thistle for its antioxidant silymarin content (it is not advised for those on hepatitis C medication)

2. Medications: Various drugs may be prescribed for the following purposes: 

1. Treat chronic viral hepatitis infections

2. Reduce immune system activity

3. Remove iron and copper from the body

4. Lower pressure in the stomach and oesophageal veins 

Surgery

As fibrosis is reversible, it does not require surgical treatment. However, if the condition deteriorates to cirrhosis, a liver transplant is the only definitive option. It replaces the damaged liver with a healthy one from a donor.

Note: The treatment approach is selected based on the patient’s health condition and the treating doctor’s opinion.  

Estimated Cost of Liver Fibrosis Treatment 

Surgery may be needed only when fibrosis progresses to end-stage liver disease. In such cases, patients may incur the following cost of treatment: 

Note: These costs are approximate. For accurate pricing details, patients are advised to contact HexaHealth experts. 

Delaying treatment for liver fibrosis can lead to serious complications, significantly impacting one’s health. Such delays can allow fibrosis to progress to cirrhosis and liver failure, where the liver can no longer perform its vital tasks. 

Additionally, untreated fibrosis can lead to life-threatening complications such as: 

1. Portal hypertension (elevated pressure in the portal vein that leads to the liver)

2. Ascites (severe fluid accumulation in the abdomen)

3. Variceal bleeding (severe bleeding from enlarged veins in the oesophagus or stomach)

4. Hepatic encephalopathy (confusion due to the accumulation of toxins) 

5. Hepatorenal syndrome (kidney dysfunction in advanced liver disease)

When to consult a doctor? 

Early diagnosis and treatment can prevent further damage to the liver. Patients should consult a specialist if they notice the following liver fibrosis symptoms or complications: 

1. Persistent fatigue 

2. Jaundice 

3. Abdominal swelling or pain 

4. Dark urine 

5. Itching

A liver fibrosis diet can help patients get the necessary nutrients and prevent long-term complications. While the exact dietary needs can vary depending on the health of individuals, some general recommendations are as follows: 

1. Fruits and Vegetables: Eat a variety of these for essential minerals, vitamins, and antioxidants that support liver health.

2. Lean Protein: Sources like legumes, fish, and poultry support liver function without overwhelming it. 

3. Healthy Fats: Nuts, avocados, and olive oil can help prevent protein breakdown in the liver. 

Some foods that must be avoided or limited for a healthy liver include: 

1. Sodium: Limit salt intake to reduce water retention and swelling in the liver.

2. Raw or Undercooked Shellfish: To reduce the risk of hepatitis A that could further harm the liver.

Liver fibrosis is a reversible condition if diagnosed early and managed properly through lifestyle changes and medical interventions. Recognising liver fibrosis symptoms can lead to timely treatment, preventing progression to more severe diseases. A proactive approach to liver health can significantly enhance quality of life and long-term outcomes.

HexaHealth is dedicated to providing comprehensive support for individuals with this condition. 

By connecting you with top doctors, we ensure liver fibrosis treatment plans are tailored to your specific health needs. Our team guides you throughout the process, from initial consultation to follow-up care. Contact us today!

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