There are about 4.5 million people who have been diagnosed with liver disease in the United States. According to the American Liver Foundation, however, there may be up to 100 million additional Americans who have some kind of liver disease but aren’t currently aware of it. If left untreated, conditions like liver fibrosis can lead to devastating outcomes like liver failure or liver cancer. Knowing the signs is the first step to a diagnosis and treatment.1

What Does the Liver Do?

The liver is an important metabolic and digestive organ that performs many vital functions in the body. One of its primary roles is related to metabolism, where it breaks down carbohydrates, proteins, and fats from food and turns them into energy or compounds that the body requires for normal function. A related liver function is the production of bile, a greenish-yellow fluid that aids in the digestion and absorption of fats and fat-soluble vitamins in the small intestine. It also synthesizes many important proteins that are used all over the body.

Apart from being a key element of the digestive system, the liver has numerous other roles to play. For instance, it serves as a storage facility for glycogen, vitamins, and minerals that the body can access when needed. Additionally, it acts as a detoxifier, filtering potentially harmful substances from the blood and breaking them down or converting them into less toxic forms for elimination. It also regulates blood composition by removing bilirubin, a waste product of red blood cell breakdown, and ammonia, a waste product of protein metabolism.

What Is Liver Fibrosis?

Because of how important the liver is to so many aspects of health, liver damage or dysfunction can have significant consequences. One of the biggest long-term dangers related to the liver is fibrosis, the accumulation of excess fibrous connective tissue. Fibrosis is technically a form of pathological wound healing, where high amounts of substances like collagen accumulate over time and cause connective tissue to replace normal liver tissue. Over time, this replacement of normal tissue with scar tissue leads to disrupted function.2

What Are the Symptoms of Liver Fibrosis?

Liver fibrosis often doesn’t present with symptoms in the early stages, which is why scar tissue can be gradually accumulating over years without the patient being aware of it. As the condition progresses, however, there are a number of signs and symptoms that become apparent:

  • Fatigue and weakness: As the liver's function becomes impaired, the individual may experience persistent tiredness and a lack of energy.
  • Weight loss: Liver damage can interfere with the liver's ability to metabolize nutrients properly, leading to a decreased appetite and unintended weight loss.
  • Nausea: Having a dysfunctional liver can promote the kind of buildup of toxins that might cause nausea and vomiting.
  • Abdominal pain: As the liver becomes scarred and enlarged, it can cause a dull ache or discomfort in the upper right side of the abdomen.
  • Jaundice: Jaundice is a yellowing of the skin and whites of the eyes that can happen as a result of the liver's inability to properly process bilirubin, one of the components of bile.
  • Itchy skin: Liver damage can also lead to elevated levels of bile salts in the bloodstream; the presence of excess bile salts in the blood can cause severe itching on the skin.
  • Edema: Fluid retention and swelling may occur due to the increased blood pressure and blood flow to the liver. This is especially concerning when fluid builds up in the abdominal cavity (ascites).
  • Confusion: In cases of advanced fibrosis and liver cirrhosis (the most severe kind of scarring), toxins build up in the brain; this can cause mental confusion, forgetfulness, and even coma (hepatic encephalopathy).

What Causes Liver Fibrosis?

Liver fibrosis can happen any time the liver experiences damage and attempts to repair itself by laying down collagen fibers and other proteins. But if the underlying cause of the damage continues indefinitely, the accumulation of scar tissue will similarly continue indefinitely. As more and more scar tissue accumulates, it disrupts the normal architecture and function of the hepatocytes (liver cells). Below are some common risk factors and conditions that may contribute to liver fibrosis:

  • Chronic viral hepatitis: One of the most common causes of liver fibrosis is a viral hepatitis infection. Chronic hepatitis can occur when exposed to a hepatovirus; the hepatitis B virus (HBV) and hepatitis C (HCV) virus are also the most common variants that can lead to fibrosis. The presence of these viruses triggers chronic inflammation, which in turn activates hepatic stellate cells that produce the collagen fibers that promote the formation of scar tissue over years or even decades.
  • Autoimmune hepatitis: This version of hepatitis is believed to be caused by a combination of genetic factors and environmental triggers. In a person with autoimmune hepatitis, the body's immune system mistakenly attacks liver cells, causing an inflammatory response. Over time, this leads to liver cell death and excessive deposition of scar tissue by stellate cells.
  • Alcoholic fatty liver disease: Another unfortunately common cause of liver damage and hepatic fibrosis is alcoholic fatty liver disease. This condition is directly related to heavy alcohol use over a number of years–often a decade or more. When alcohol is metabolized by the liver, it produces acetaldehyde, a toxic byproduct that disrupts the pathways that normally help regenerate liver tissue and break down scar tissue.
  • Non-alcoholic fatty liver disease: As the name implies, non-alcoholic fatty liver disease (NAFLD) involves a similar type of liver damage but without alcohol as a major factor. People suffering from NAFLD have a buildup of excess fat in the liver (steatosis) that can cause oxidative stress and liver cell injury. NAFLD is typically associated with other health conditions like obesity and type 2 diabetes.
  • Biliary tract diseases: The bile duct leads from the liver to the small intestine, but if this conduit is blocked (cholestasis) for some reason, the resulting inflammation and cell death can cause fibrosis. Examples of conditions that can lead to a blockage include primary sclerosing cholangitis, primary biliary cholangitis, and pancreatitis.
  • Inherited diseases: There are also some inherited chronic liver diseases that can cause the kind of damage that results in fibrosis. Hemochromatosis and Wilson’s disease are two examples.

Diagnosis and Treatment

For mild to moderate cases of liver fibrosis, it’s possible to reverse some of the damage with proper treatment of the underlying cause. For more advanced cases and cases of liver cirrhosis, the damage is unfortunately permanent and treatment involves management of symptoms. To diagnose the condition, a gastroenterologist typically performs a series of blood tests and imaging tests of the liver itself. In some situations, a liver biopsy is necessary in order to test a tissue sample.

Advances in diagnostic technology over the years have also provided additional techniques for evaluating the health of the liver. Once such technique involves use of the FibroScan® system, a medical device that can non-invasively assess liver stiffness and steatosis. This allows a gastroenterologist to determine the presence and extent of liver fibrosis without the need for a biopsy. The FibroScan® system uses ultrasound technology to measure the velocity of low-frequency sound pulses as they travel through liver tissue. It is painless and quick, usually complete in about 10 minutes.

Once liver fibrosis has been diagnosed, there are a variety of approaches to treatment:

  • Address underlying problems: Some methods are related to the underlying cause; for instance, a chronic hepatitis infection may need to be treated via antiviral therapies. For autoimmune hepatitis, immunosuppressive drugs can reduce inflammation. There are also vaccinations that can prevent getting an infection in the first place.
  • Medication: Antifibrotic drugs can be used to directly reduce fibrosis, while anti-inflammatory drugs can keep inflammation down.
  • Lifestyle changes: Since there are numerous potential causes of liver injury related to lifestyle choices, some patients need to make changes. In addition to the cessation of alcohol consumption, patients are also encouraged to adopt a healthier diet that is low in fat, sugar, and salt. Regular exercise is also important for a healthy liver and a healthy body overall.
  • Surgery: In the most extreme cases of liver fibrosis and cirrhosis, the only remaining option is the removal of the damaged tissue. But since a human can’t live without a liver, a liver transplantation from a healthy donor is necessary.

Speak With a Gastroenterologist Today

We don’t often think much about our liver, but it is a vital organ that performs many functions in the body. Liver fibrosis is just one of the potential conditions that can threaten your health. If you have been experiencing any of the symptoms noted above, it’s important to heed the signs and make an appointment with a gastroenterologist. At Cary Gastro, we are passionate about providing excellent digestive healthcare; please contact us today to request an appointment.

1https://liverfoundation.org/about-your-liver/facts-about-liver-disease/how-many-people-have-liver-disease
2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC546435/