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What is liver fibrosis?

Normally, the liver performs a wide range of essential metabolic functions. For example, the liver neutralizes alcohol and many other toxic substances, manufactures cholesterol and bile, and stores vitamins, minerals, and glucose.

Liver fibrosis occurs when healthy liver cells are replaced by an excess of fibrous tissue (connective tissue composed mostly of fibers).

The fibrous tissue is incapable of carrying out normal liver functions. Thus, if it replaces a significant amount of healthy tissue, the effects are felt throughout the body. There are two major types of liver fibrosis:

• Passive liver fibrosis, which results from a condensation of existing fibers.
• Active liver fibrosis, which results from the development of new fibers.

Only in rare instances is fibrosis the primary problem; more often, it is secondary to some other liver disease such as cirrhosis.

How is liver fibrosis diagnosed and treated?

If blood tests suggest liver fibrosis, a liver biopsy is performed. The biopsy can determine whether fibrosis is present, and also distinguish between the passive and active forms of the disease. Treatment depends upon the underlying cause of the fibrosis.

What can I do myself?
The presence of fibrosis or any other form of liver disease mandates abstaining from alcohol. Medications that are harmful to the liver should be stopped or the dosage reduced as much as possible. A doctor’s approval should be sought before taking any drugs, including vitamin and mineral pills and over-the-counter medications. Women usually are advised not to take birth control pills.

A person who works with chemicals that are harmful to the liver may be advised to find a different type of job. A diet low in fat and salt may also be recommended .

When should I see my doctor?
Any persistent, generalized feelings of illness or appetite or weight loss warrant a medical consultation. Call a physician immediately if jaundice (yellowing of the skin and eyes) develops.

What will the doctor do?
The doctor ‘s primary task is to identify the underlying cause of the fibrosis and to initiate appropriate treatment. If active fibrosis is diagnosed, the doctor may prescribe medications to inhibit the formation of new fibers. These drugs often include penicillamine or colchicine (drugs used to treat rheumatic disorders such as severe arthritis or gout), or analogs of proline, an amino acid.

What causes liver fibrosis?

The condition arises from some sort of trauma or injury to the liver, including:

• Damage caused by excessive alcohol intake or exposure to other harmful chemicals.
• Damage caused by drugs taken to treat other disorders, such as methotrexate, an anticancer drug.
• liver inflammation due to hepatitis or some other infection.
• Chronic obstruction of the flow of bile.
• Reduced blood circulation in the liver.
• Complications from such diverse disorders as iron overload and Wilson’s disease (the buildup of copper and other minerals in the liver).

The course of liver fibrosis

Fibrosis may be preceded by the development of excess fat in the liver, which dis- places normal cells. This can lead to an enlarged liver, which causes pain when the overlying abdominal area is pressed.

The early symptoms of liver disease -loss of appetite and weight, nausea and vomiting, fatigue, and indigestion, among others – may be vague and are often attributed to many other illnesses. Only when jaundice appears is a liver disorder suspected .

The impact of fibrosis on the structure and function of the liver depends not only on its extent but also on its localization. Fibrosis in various areas of the liver can lead to diverse problems, including atrophy and death of certain liver cells, blockage of circulation within the liver, an increase in pressure within the veins leading to the liver (portal hypertension), and abnormalities in the flow of bile (cholestasis) .

If fibrosis worsens, it may lead to cirrhosis, with the liver becoming shrunken, hard, and knobby. Fortunately, the liver has an amazing ability to regenerate itself once the underlying cause of the fi- brosis is controlled or cured. If the fibrosis progresses, however, it can lead to total destruction of the liver and death, unless a liver transplant is performed.

Is liver fibrosis dangerous?
Yes, it can be. If fibrosis is allowed to proceed unchecked, it can lead to potentially fatal liver damage.

What can I do to avoid liver fibrosis?

• Avoid excessive use of alcohol.
• Wear a protective mask when working with chemicals that are toxic to the liver.
• Have any infections treated promptly.
• Avoid activities such as eating raw shellfish that increase the risk of hepatitis. Talk to a doctor about hepatitis immunization if there is a high risk of contracting hepatitis (e.g., if there is a family member or sexual partner with the disease).

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