Overview

Liver fibrosis occurs when the healthy tissue in your liver is scarred and therefore cannot function as well. Fibrosis is the first step in the healing of the liver. If more of the liver is scarred later, it is called cirrhosis of the liver.

While some animal studies have shown that the liver can regenerate or heal on its own, the liver generally does not heal when humans sustain liver damage. However, medications and lifestyle changes can help keep fibrosis from getting worse.

What are the stages of liver fibrosis?
There are different hepatic fibrosis staging scales, on which a doctor will determine the degree of liver damage. Since staging can be subjective, each scale has its own limits. A doctor might think that one liver is slightly more scarred than another. However, doctors usually assign liver fibrosis a stage because it helps the patient and other doctors understand the degree of liver damage in a person.

One of the most popular scoring systems is the METAVIR scoring system. This system assigns a score for “activity” or prediction of fibrosis progression and for the level of fibrosis itself. Doctors can usually only assign this score after taking a biopsy or tissue sample from a piece of liver. Activity levels range from A0 to A3:

A0: no activity
A1: light activity
A2: moderate activity
A3: intense activity
The stages of fibrosis range from F0 to F4:

F0: no fibrosis
F1: portal vein fibrosis without septa
F2: portal vein fibrosis with little septa
F3: many septa without cirrhosis
Q4: cirrhosis
Therefore, a person with the most severe form of the disease would have a METAVIR A3, F4 score.

Another scoring system is Batts and Ludwig, who rate fibrosis on a scale from grade 1 to grade 4, with grade 4 being the most severe. The International Association for Liver Research (IASL) also has a scoring system with four categories ranging from mild chronic hepatitis to severe chronic hepatitis.

What are the symptoms of liver fibrosis?
Doctors often do not diagnose liver fibrosis in its mild to moderate stages. This is because liver fibrosis usually does not cause symptoms until the liver is damaged.

As a person progresses with their liver disease, symptoms may include:

Loss of appetite
Difficulty thinking clearly
Fluid buildup in the legs or stomach
Jaundice (where the skin and eyes appear yellow)
nausea
unexplained weight loss
weakness

What are the causes of hepatic fibrosis?
Liver fibrosis occurs after a person has suffered an injury or inflammation of the liver. Liver cells stimulate wound healing. During this healing process, excess proteins such as collagen and glycoproteins build up in the liver. After many cases of repair, liver cells (called hepatocytes) cannot repair themselves. The excess protein forms scar tissue or fibrosis.

There are different types of liver disease that can cause fibrosis. These include:

Autoimmune hepatitis
Biliary obstruction
Iron overload
non-alcoholic fatty liver disease, which includes non-alcoholic fatty liver disease (NAFL) and non-alcoholic steatohepatitis (NASH)
Viral hepatitis B and C.
alcoholic liver disease
According to The LancetTrusted Source, the most common cause of liver fibrosis is non-alcoholic fatty liver disease (NAFLD), while the second cause is alcoholic liver disease due to long-term excess alcohol.

Treatment options
The treatment options for hepatic fibrosis usually depend on the underlying cause of the fibrosis. If possible, a doctor will treat the underlying condition to reduce the effects of the liver disease. For example, if a person drinks too much alcohol, a doctor may recommend a treatment program that will help them stop drinking. If a person has NAFLD, a doctor may recommend changing their diet to lose weight and taking medication to promote better blood sugar control. Exercise and weight loss can also help reduce the progression of the disease.

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