This article gives an overview of liver fibrosis, including the symptoms, causes, diagnosis, and treatment.
Your liver is one of the biggest internal organs. It has many jobs, including aiding digestion, storing energy, making blood clotting components, and removing waste and microorganisms. The liver is also able to regenerate, or regrow, itself to repair damage.
Normally, the liver can make new cells when something harms it. The new cells replace the old ones that have died. However, this does not work the way it should with a diseased liver or if liver injury is continuous or severe.
Instead, the attempts at repair cause scarring in place of functioning liver cells. Scars are fibrous tissue, hence the name fibrosis. Another name for liver fibrosis is hepatic fibrosis.
In the United States, the most common conditions that result in liver fibrosis are alcohol-related liver disease, chronic hepatitis, and nonalcoholic fatty liver disease (NAFLD). Having these conditions puts you at risk of developing liver fibrosis.
Blood tests and imaging exams can help find signs of liver fibrosis. When found early, it is possible to cure or reverse liver fibrosis. If liver fibrosis remains undetected and the damage continues, it can progress to cirrhosis.
The difference between liver fibrosis and cirrhosis is that cirrhosis is permanent, irreversible scarring. The liver becomes smaller and mostly consists of hard scar tissue. Once cirrhosis develops, symptoms and problems can appear.
The scarring of liver fibrosis can interfere with the liver’s ability to work efficiently. Fibrosis itself does not cause any symptoms. You can have liver fibrosis and not know it.
Doctors can find signs of liver fibrosis with liver function tests (LFTs), which are blood tests. Most people get LFTs during routine physical exams.
It is also possible to see liver fibrosis on imaging exams. Doctors may notice this if you have imaging exams for another condition. Seeing your doctor regularly for an annual exam can help uncover potential liver problems while there is still time to address them.
If fibrosis progresses to cirrhosis, common symptoms can include:
- easy bruising and bleeding
- fatigue, confusion, and weakness
- itching
- poor appetite, nausea, and weight loss
- swelling of the abdomen (ascites) and legs (edema)
- yellowing of the skin and eyes (jaundice)
Liver cirrhosis is a serious disease that can lead to life threatening complications. Seek immediate medical care for symptoms of cirrhosis.
Liver fibrosis occurs when the liver is diseased or sustains a chronic or severe injury. As the liver tries to repair itself by making new cells, it is not able to do so. Instead, fibrous scar tissue replaces the dead liver cells. This scar tissue eventually prevents the liver from functioning normally.
Learn more about what the liver does.
Liver fibrosis is a symptom of several underlying conditions. In the U.S., the most common causes are:
- Alcohol use disorder: The liver breaks down alcohol you drink so your body can get rid of it. This process produces harmful byproducts that damage liver cells. The more alcohol you drink, the worse the damage becomes.
- Chronic hepatitis C infection: The hepatitis C virus (HCV) infects the liver, causing damage and inflammation. Most people with HCV do not have symptoms for several years after becoming infected. As a result, it is common to have liver problems, including fibrosis, at diagnosis.
- NAFLD: NAFLD is fat buildup in the liver that can cause inflammation. The inflammation leads to damage and fibrosis. This is not related to alcohol use. Instead, it tends to affect people with obesity and conditions related to obesity, such as type 2 diabetes.
Other potential underlying causes of liver fibrosis include:
- autoimmune diseases
- bile duct blockages
- certain medications
- conditions that cause decreased blood flow to the liver
- hereditary metabolic disorders
There is also a congenital form of liver fibrosis that is present at birth.
A number of factors increase the risk of developing liver fibrosis, including:
- having certain hereditary conditions, such as alpha-1 antitrypsin deficiency, hemochromatosis, and Wilson disease
- having certain medical conditions, including chronic hepatitis C and type 2 diabetes
- having obesity with fat distribution mainly in the abdomen
- drinking alcohol in excess
- taking certain drugs, such as amiodarone, corticosteroids, isoniazid, methotrexate, and methyldopa
You may be able to lower your risk of liver fibrosis by:
- controlling blood sugar levels and blood pressure
- limiting or stopping alcohol consumption and getting help for alcohol use disorder
- losing weight, which is the most effective treatment for NAFLD
- maintaining a moderate body weight through a healthy diet and exercise
Seeing your doctor regularly will help identify liver fibrosis in the early stages. In general, the earlier you find potential liver problems, the more likely it will be that you can reverse any damage.
If your doctor suspects liver fibrosis, they will likely order testing. Blood tests can give your doctor information about liver function. When LFTs are high, it tells your doctor that your liver may have a disease or injury.
Your doctor may also order imaging exams. This includes ultrasound, CT scan, or MRI, which can identify scarring and liver damage and measure stiffness.
The gold standard for diagnosing liver fibrosis is a liver biopsy. A healthcare professional can examine the sample for abnormal changes to the microscopic structure of liver tissue. They can then stage liver fibrosis if it is present.
One of the classic scoring systems for liver fibrosis is METAVIR. It has five stages:
- F0: normal liver with no fibrosis (scarring)
- F1: mild fibrosis, but liver structure and function are still normal
- F2: mild to moderate fibrosis and impaired function
- F3: severe fibrosis in which scarring has disrupted normal blood flow through the liver and function is further impaired
- F4: cirrhosis, which is permanent scarring and irreversible loss of liver function
There is no specific treatment for liver fibrosis. Since it is a symptom of another liver problem, the most effective way to treat it is to address the underlying condition.
Removing the cause of the liver damage will stop the fibrosis and allow the liver to heal. In the early stages, the damage is usually reversible. However, even advanced fibrosis (e.g., stage F3) can show improvement once the injury ceases. The liver will slowly heal itself with time.
For the most common causes, treatment involves the following:
- Alcohol use disorder: Stop all alcohol consumption.
- HCV infection: Take antivirals, which can successfully treat more than 95% of people with the virus.
- NAFLD: Lose weight, which is the most effect treatment for this condition.
The less common causes also have therapies that can help stop liver damage.
When fibrosis progresses to cirrhosis, liver transplantation may be an option.
The main complication of liver fibrosis is progression to cirrhosis. Cirrhosis can lead to life threatening complications, including:
- hepatic encephalopathy, which is a buildup of toxins that affects the brain and can lead to coma and death
- kidney failure
- liver failure and liver cancer
- portal hypertension, which is high blood pressure in a large abdominal vein that can lead to esophageal varices, enlarged spleen, and other problems
Liver fibrosis is a symptom of other liver conditions. It occurs when the liver tries to repair itself but injury or disease gets in the way. Instead of the liver replacing dead cells with new ones, scar tissue forms.
Treatment is often able to reverse this process. Without treatment, liver fibrosis can progress to cirrhosis, which is permanent scarring.
