Liver fibrosis: Symptoms, causes and treatment

What is liver fibrosis?

Liver fibrosis happens when scar tissue builds up in your liver because of repeated damage. Your liver can usually heal itself by repairing and replacing damaged liver cells, but if it keeps getting injured, it eventually develops scar tissue, which then leads to inflammation.

When it gets serious, fibrosis can stop your liver from working as well as it should – blocking its blood flow and affecting its many important functions, which include fighting infections and breaking food down for energy.

There are many things that cause liver fibrosis, including drinking too much alcohol and viral infections like hepatitis B.

If fibrosis is picked up and treated early enough, the damage can usually be reversed. But if it isn’t, this damage may become permanent and cause cirrhosis, which may stop your liver working.

What are the stages of liver fibrosis?

There are different stages of fibrosis, each based on how serious the damage is. Doctors use different scales for defining these stages – usually only after you’ve had a liver

(where a doctor takes a tissue sample of your liver and looks at it under a microscope).

One of the scales that’s commonly used by doctors is the METAVIR scoring system scale. It grades fibrosis according to the progression or ‘activity’ of the disease from A0 to A3:

• A0: no activity
• A1: mild activity
• A2: moderate activity
• A3: severe activity

It also grades the level of fibrosis from F0 to F4, where F0 is ‘no fibrosis’ (the least serious stage) and F4 is ‘

’ (the most serious stage). So, if you have the most serious form of liver disease, you’d have an A3, F4 METAVIR score.

Liver fibrosis symptoms

There are many different types of

that can lead to liver fibrosis, but it often takes many months or years of damage and inflammation for scar tissue to develop in your liver. While this is happening, you usually won’t know you have fibrosis, because it doesn’t tend to cause symptoms in its early stages.

However, as it progresses, you may start showing symptoms of cirrhosis, such as:

• loss of appetite
• losing weight without trying to
• feeling very tired
• dark coloured pee
• yellowing of the whites of your eyes and skin (
  jaundice
  )
• swollen legs (
  oedema
  ) and swollen tummy (ascites) – from a build-up in fluid

When to see a doctor about liver fibrosis

It's possible to stop fibrosis from getting worse if it’s diagnosed and treated early, so see a doctor as soon as possible if you think you may have it or you may be at risk of it. You should do this even if you feel OK, as fibrosis doesn’t usually cause symptoms.

Serious cases of liver disease can cause complications that need emergency medical treatment. Call an ambulance or go to the emergency department immediately if:

• you feel confused or drowsy
• you’re vomiting blood or something that looks like coffee grounds
• your poo looks bloody or dark (like tar)
• you’re bleeding from any part of your body, and you can’t stop the bleeding

Liver fibrosis causes

There are many causes of liver fibrosis, including medical conditions and taking certain medicines. But, sometimes the cause isn’t clear.

The most common causes include:

• drinking too much alcohol over many years (
  alcohol misuse
  ), which may cause alcoholic liver disease, also known as
  alcohol-related liver disease
  (ARLD)
• hepatitis B
  or
  hepatitis C
  – viral infections that cause liver inflammation
• nonalcoholic steatohepatitis (NASH) – a serious form of
  nonalcoholic fatty liver disease (NAFLD)
  (a build-up of fat in your liver)

Other causes may include autoimmune hepatitis (caused by your immune system accidentally attacking your liver cells) and

.

Rare inherited (genetic) diseases like

, where too much iron builds up in your body and affects your organs, and Wilson’s disease, in which too much copper builds up in your tissues and damages your organs, can also cause fibrosis.

How is liver fibrosis diagnosed?

As you don’t usually get symptoms of fibrosis, you may only find out you have it when you’ve been tested for another problem that has symptoms, like cirrhosis.

A doctor will usually ask about your symptoms and any medical conditions you have. If they suspect you may have liver fibrosis, you may need some tests, including:

• blood tests
  – these will show how well your liver is or isn’t working
• a
  CT scan
  or
  MRI scan
  – these imaging scans will check for any changes to your liver
• a biopsy of your liver

If the tests show your liver is damaged, you may need to see a specialist liver doctor called a hepatologist.

Liver fibrosis treatment

If you have liver damage that’s in its early stages, it can be reversed if it’s diagnosed early enough and if its cause can be treated or cured. Treatment for fibrosis aims to stop further damage and progression to cirrhosis.

The exact treatment you’ll need for liver fibrosis usually depends on its cause, but it may include:

• cutting down on how much alcohol you drink, or not drinking it at all – but don’t do this without a doctor’s guidance, as cutting down too quickly can be dangerous. Read more about
  how much alcohol is too much
  and how to
  get the support you need for alcohol misuse
• losing weight if you have NAFLD – ask a doctor or nutritionist for help on how to safely lose it
• eating a
  healthy, balanced diet
  – find out about
  foods that are good for your liver
• antiviral medicines that get rid of the virus if you have an infectious type of hepatitis, like hepatitis B or C
• not taking any medication that may be causing the damage – but don’t stop taking any medication without speaking to a doctor first
• taking medicine to remove excess iron or copper from your blood if you have haemochromatosis or Wilson’s disease

Currently, there’s no medicine a doctor can give you to stop scar tissue forming.

Other ways you can lower your chance of getting liver damage in general include:

• quitting smoking
• exercising regularly to make sure you’re a healthy weight – find out about
  how to get active
• cutting down salt in your diet
  to lower your chances of getting swelling in your feet, legs and tummy
• practising good hygiene to make sure you don’t get any infections like hepatitis
• getting recommended vaccinations, like a
  flu vaccine
  every year or
  travel vaccines
  if needed – speak to a doctor about these

Can you prevent liver fibrosis?

It’s much easier to prevent fibrosis and cirrhosis if liver disease is picked up early. But the cause of fibrosis can also determine if it’s preventable or not. For example, losing weight can reduce the risk of liver disease caused by being overweight or obese, and cutting down on or not drinking any alcohol can prevent liver damage from alcohol misuse.

But, if you have autoimmune hepatitis or an inherited disease like Wilson’s disease, it can be harder to prevent fibrosis – although it’s not impossible if these conditions are diagnosed and treated early enough.

What can you expect if you have liver fibrosis?

If you find out you have early-stage liver fibrosis, this can be reversed, so it’s best to get treatment and make lifestyle changes early on with the guidance of a doctor. The liver is a very tough organ, so it can usually recover – and it usually takes years to cause permanent damage to your liver.

But, if fibrosis is left untreated, it may (but not always) lead to cirrhosis and its many complications, which can include liver failure and

.

Key takeaways

• the liver can usually heal itself, but when it keeps getting damaged, it develops scar tissue, which is known as fibrosis
• you usually won’t know you have fibrosis because it doesn’t tend to cause symptoms
• there are many causes of liver fibrosis, including medical conditions and medicines – but sometimes, the cause isn’t known
• if fibrosis is left untreated, it may lead to the last stage of liver disease, which is known as cirrhosis
• treatment for fibrosis depends on the cause and may include cutting down on alcohol, losing weight if you need to and taking certain medicines