Hepatic Fibrosis: Causes, Symptoms and Treatment

by | Jun 6, 2019 |

Hepatic fibrosis is a complication in which scar tissue is formed abnormally in the liver due to repeated liver injury. When the liver is injured, the hepatic cells at the location of the injury die off, leaving behind a mesh of connective tissue. Normally, the liver produces new hepatic cells and attaches them to the connective tissue to heal the injury. However, long-lasting liver injury, repetitive liver injury or inflammation may result in the formation of excessive scar tissues that causes hepatic fibrosis. The scar tissue disrupts the normal functioning of the liver and causes structural changes in the liver.

Causes of Hepatic Fibrosis

Hepatic fibrosis may be a result of various etiologies such as:

  • Autoimmune hepatitis
  • Storage disorders such as fructosemia, galactosemia, etc
  • Chronic viral hepatitis B or C
  • Bacterial and parasitic infections such as brucellosis, echinococcosis, etc
  • Portal vein thrombosis
  • Alcohol consumption
  • Drugs such as amiodarone, chlorpromazine, isoniazid, etc
  • Primary biliary cholangitis
  • Bile duct deformity (biliary atresia)
  • Fat accumulation in the liver (fatty liver disease)
  • Hemochromatosis (iron buildup in body)
  • Wilson’s disease (copper accumulation in the liver)

Symptoms of Hepatic Fibrosis

Hepatic fibrosis may not present with any noticeable symptoms but may cause impaired functioning and regeneration of the liver. Hepatic fibrosis may also lead to portal hypertension and hepatic cirrhosis. When hepatic fibrosis progresses to hepatic cirrhosis, it may result in multiple symptoms such as:

  • Loss of appetite
  • Fatigue and weakness
  • Weight loss
  • Nausea and vomiting
  • Abdominal pain
  • Jaundice
  • Edema in the lower limbs
  • Itchy skin
  • Dark urine
  • Drowsiness
  • Confusion
  • Loss of libido
  • Fluid accumulation in the abdomen causing bloating (ascites)

Furthermore, hepatic cirrhosis also increases the risk of developing liver cancer.

Diagnosis of Hepatic Fibrosis

Hepatic fibrosis is diagnosed by taking a thorough medical history of the patient and by performing some tests. Blood tests may be done to evaluate liver enzymes such as ALT and AST. Imaging tests including abdominal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), ultrasound elastography and magnetic resonance elastography (MRE) are performed to check the state of the liver. Also, a liver biopsy to check for liver damage may also be performed. The results are then used to classify hepatic fibrosis into one of the multiple stages based on the following scales:

  • Metavir scoring system: A0 (no activity) to A3 (severe activity) or F0 (no fibrosis) to F4 (cirrhosis)
  • Ishak fibrosis scoring system: 0 (no fibrosis) to 6 (likely or definite cirrhosis)
  • Batts–Ludwig scale: 0 (no fibrosis) to 4 (definite or likely cirrhosis)

Treatment of Hepatic Fibrosis

Treatment of hepatic fibrosis mainly involves the identification and resolution of the root cause. Successful resolution of the root cause at the early stages of fibrosis can reverse the damage caused to the liver. The steps taken to resolve the root cause may be:

  • Reduction or cessation of alcohol consumption
  • Administration of antiviral medications to treat viral hepatitis
  • Removal of excessive iron and copper from the body by using chelating agents
  • Removal of bile obstructions
  • Dietary changes to reduce weight and to control fat, cholesterol and sugar levels in the body
  • Cessation of administration of medications that cause fibrosis
  • Administration of immunosuppressants

However, if liver fibrosis advances to liver cirrhosis, the damage is irreversible. Further medications to reduce portal hypertension, remove excess fluid and remove toxins are required in patients with liver cirrhosis. Also, a liver transplant may be required in advanced stages of liver cirrhosis.


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