In liver fibrosis, previous disease causes healthy liver tissue to break down and be replaced by collagenous connective tissue. This scarring often forms a transitional stage to cirrhosis.
What is liver fibrosis?
Fibrosis is the medical term for an increase in connective tissue within an organ. In the case of liver fibrosis, replacement of functional liver tissue into collagenous connective tissue (scar tissue) occurs. In most cases, this is a non-reversible process, so that the liver tissue cannot recover from the fibrosis. If high-grade liver fibrosis is present, it is also referred to as liver cirrhosis.
Causes
Liver fibrosis is not a disease in its own right. Instead, it represents a symptom that results from a variety of pre-existing conditions. Among the most common triggers of liver fibrosis is the overconsumption of alcohol. The breakdown of alcohol from the body is done in the liver. However, the constant stress of alcohol on this important organ can result in fatty liver. While fatty liver is sometimes still reversible at an early stage, fibroblasts increasingly develop at later stages. This refers to cells that produce connective tissue. They are ultimately responsible for the development of liver fibrosis. The liver tissue can then no longer regenerate. However, not only alcohol is responsible for the development of fatty liver and liver fibrosis, but also the excessive use of medications such as steroid hormones. Other possible causes are obesity and diabetes mellitus. Another common cause of liver fibrosis is viral hepatitis. It is mostly caused by the hepatitis B and hepatitis C viruses. The viruses cause inflammation of the liver tissue, which has a damaging effect on healthy tissue. If the liver inflammation lasts longer than six months, doctors refer to it as chronic hepatitis. In its course, the healthy liver cells are displaced by the fibroblasts. The formation of connective tissue eventually leads to liver fibrosis. If fibrosis continues for years, there is a risk of liver cirrhosis. Other possible causes of liver fibrosis include chronic congestive hepatitis, often caused by right heart failure, prolonged toxicity to the liver, alpha-1 antitrypsin deficiency, and chronic cholestasis.
Symptoms, complaints, and signs
Typical symptoms are rarely seen with liver fibrosis. It is not uncommon for her to have no symptoms at all. Thus, it is a disease stage that is not yet too pronounced. Symptoms that provide evidence of liver disease are often not detectable until liver cirrhosis. In some cases, liver fibrosis is accompanied by atypical symptoms such as loss of appetite, loss of weight, fatigue, blood clotting disorders and frequent bleeding gums. Some patients also have an intolerant reaction to alcohol. However, liver disease is not automatically thought of with these signs, because they can also indicate other diseases. More definite symptoms of liver disease only manifest themselves in the advanced stages. These include, above all, jaundice (icterus), in which the patient’s skin and eyes turn yellowish. Some patients also suffer from itching all over the body.
Diagnosis and course of the disease
For the diagnosis of liver fibrosis, the physician can resort to several examination options. Sonography (ultrasound examination) is considered a proven procedure. This procedure allows the structural proliferation of the liver to be detected, although it is not uncommon for this to be done too late because the patient usually decides to seek medical treatment only when symptoms appear. An analysis of the blood is also one of the examination methods. For example, collagen IV and elevated liver enzymes indicate liver fibrosis. However, an examination is only useful in an advanced stage. A puncture, in the course of which the physician removes liver tissue, provides certainty in establishing the diagnosis. The tissue is then examined under a microscope.Depending on how advanced the liver fibrosis is, medicine divides it into different degrees of severity from F0 to F4. Stage F0 does not yet show any connective tissue proliferation of the fibers, while F1 is low-grade fibrosis. F2 and F3 are classified as moderate and high grade fibrosis, respectively. F4 is advanced liver fibrosis or cirrhosis. The course of liver fibrosis depends on the underlying disease. In the case of hepatitis, it is not uncommon for fibrosis to progress to cirrhosis. Normally, liver fibrosis cannot regress, so promising treatment should begin as early as fatty liver.
Complications
The symptoms and complications of liver fibrosis usually depend greatly on the stage of the disease. However, if left untreated, this can also lead to the death of the affected person in the worst case, so that liver fibrosis must be examined and treated by a doctor in any case. Patients often suffer from weight loss and loss of appetite. Gum bleeding and coagulation disorders may also occur. Patients also cannot tolerate alcohol and, in the further course of liver fibrosis, also suffer from jaundice. The entire body may also be affected by itching, which leads to very unpleasant feelings and a severe reduction in the quality of life. However, the further course of the disease strongly depends on the cause of the liver disease, so that a general prediction is usually not possible. In most cases, treatment can take place with the help of medication and is usually based on the symptoms. No particular complications occur. In severe cases, affected individuals may also require a liver transplant. It is also possible that liver fibrosis will reduce the life expectancy of the affected person.
When should you see a doctor?
When signs of liver disease appear, a doctor must be consulted. Symptoms such as loss of appetite, fatigue, blood clotting disorders or jaundice indicate fibrosis, which must be investigated and, if necessary, medically treated. If this is done at an early stage, further complications or late effects can be avoided. A visit to the doctor is indicated at the latest when external changes or cardiovascular complaints occur. People who regularly consume alcohol or take medication should see a doctor quickly if they experience any of the above symptoms. People with obesity, diabetes or a viral disease must also have unusual signs of illness clarified immediately, as there is an increased risk of developing liver fibrosis. The primary care physician can make an initial tentative diagnosis and refer the patient to a specialist in liver disease. Further treatment usually takes place in the hospital. In the case of liver transplantation, a longer hospital stay is necessary. If the patient’s health deteriorates massively during treatment, it is best to inform the emergency medical services. A specialist center for liver disease can provide further information on liver fibrosis and help those affected with therapy.
Treatment and therapy
Treatment of liver fibrosis focuses on treating the underlying disease. Thus, by treating hepatitis, fibrosis can often be stopped. Sometimes there is even a regression. However, it is important to start treatment at an early stage of the disease if possible, as this increases the chances of success. So far, there is no possibility of stopping the progression of liver fibrosis with drugs. However, promising experimental therapeutic approaches are now available. If the patient suffers from advanced fibrosis, treatment is limited to alleviating the symptoms. This includes a change in diet, sufficient exercise, and surgical obstruction of the bile ducts. In some patients, liver transplantation may also be useful.
Outlook and prognosis
The course that liver fibrosis takes depends on several factors. These include the progress of the disease, the patient’s constitution, and the type of therapy. The prognosis is worse if other diseases are present. If the cause of liver fibrosis cannot be determined, no targeted treatment is possible.Symptomatic therapy is not very promising in liver fibrosis, since the symptoms are usually only clearly noticeable in the final stages of the disease. The prognosis depends on the causative disease. Chronic hepatitis can cause liver cirrhosis in the long term. If chronic obstructive cholestasis is causative, the disease may arrest. Complete recovery is possible by papillotomy. The F-score also has an impact on prognosis. The extent of the disease is divided into five levels, with F0 describing incipient liver fibrosis and F4 describing advanced liver fibrosis. The higher the score, the more negative the prognosis. A more precise prognosis can be made by the physician. For this purpose, the physician in charge will take a medical history and consider the previous course of the disease. In addition, he can refer to statistics to support the prognosis.
Prevention
The causes of liver fibrosis vary, and not every trigger can be prevented. However, moderate consumption of alcohol and medications and reduction of excess weight can counteract some forms of fibrosis.
Follow-up
In cases of liver fibrosis, follow-up care measures are usually severely limited, so the affected person should see a doctor in the first instance. This is a serious disease, so early diagnosis should definitely take place. This is the only way to prevent further deterioration of the symptoms. If liver fibrosis is not treated properly or is treated late, it can even lead to the death of the affected person in the worst case. Most sufferers of this disease are dependent on taking various medications. Care must always be taken to ensure that the correct dosage is given and that the medication is taken regularly. If there are any uncertainties or questions, a doctor should be consulted first. However, if the medication does not work or does not lead to the desired success, the transplantation of a liver is usually necessary. This cannot always be done and is not always successful, so that the life expectancy of the affected person is significantly reduced due to liver fibrosis. After surgery, however, the affected person should rest and take care of his body in any case. In doing so, physical exertion or stressful activities should be refrained from.
What you can do yourself
If liver fibrosis has been diagnosed, the trigger must be determined and specifically treated. In most cases, the complaints are based on excessive alcohol consumption, which must be stopped accordingly or at least greatly reduced. If an unhealthy diet is the cause, the diet must be changed. A healthy lifestyle is generally sensible, because exercise and a balanced diet strengthen the liver and prevent liver fibrosis from progressing. People suffering from obesity should reduce their body weight. If serious diseases of the heart or gall bladder are the cause, medical treatment is required. In consultation with the doctor, specific measures can then be taken to alleviate the symptoms. In general, medical preparations supported by natural painkillers and sedatives help. Natural remedies include arnica, chamomile and motherwort. These remedies help with tension headaches and pain in the liver area. From homeopathy, the preparations Belladonna and Aconitum are offered. Ointments and creams from natural substances such as lemon balm or eucalyptus help against itching. Parallel to this symptomatic treatment, the underlying disease must be treated medically to prevent the development of liver cirrhosis.