Many conditions can damage the liver.
Fibrosis itself causes no symptoms, but severe scarring can result in cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more
, which can cause symptoms. Doctors can often diagnose fibrosis and estimate its severity based on results of blood and imaging tests, but sometimes liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more is required.
Treatment involves correcting the underlying condition when possible.
Fibrosis and cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more are not specific disorders. Instead, they are the result of other causes of liver damage.
Fibrosis develops when the liver is repeatedly or continuously damaged. After a single episode of injury, even if severe (as with acute hepatitis Overview of Acute Viral Hepatitis Acute viral hepatitis is inflammation of the liver, generally meaning inflammation caused by infection with one of the five hepatitis viruses. In most people, the inflammation begins suddenly... read more ), the liver commonly repairs itself by making new liver cells and attaching them to the web of connective tissue (internal structure) that is left when liver cells die. However, if injury is repeated or continuous (as occurs in chronic hepatitis Overview of Chronic Hepatitis Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Common causes include hepatitis B and C viruses and certain drugs. Most people have no symptoms, but some have vague... read more ), liver cells attempt to repair the damage, but the attempts result in scar tissue (fibrosis). Fibrosis can develop more rapidly when it is caused by a blockage in the bile ducts Overview of Gallbladder and Bile Duct Disorders The liver produces bile, a greenish yellow, thick, sticky fluid. Bile aids digestion by making cholesterol, fats, and fat-soluble vitamins easier to absorb from the intestine. Bile also helps... read more 
.
Scar tissue replaces the liver cells and, unlike liver cells, performs no function. Scar tissue can distort the liver's internal structure and interfere with blood flow to and in the liver, limiting the blood supply for the liver cells. Without enough blood, these cells die, and more scar tissue is formed. Also, blood pressure in the vein that carries blood from the intestine to the liver (portal vein) increases—a condition called portal hypertension Portal Hypertension Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches. Cirrhosis (scarring that distorts... read more .
Fibrosis can sometimes be reversed if the cause is identified promptly and corrected. However, after months or years of repeated or continual damage, fibrosis becomes widespread and permanent. The scar tissue can form bands throughout the liver, destroying the liver’s internal structure and impairing the liver’s ability to regenerate itself and to function. Such severe scarring is called cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more .
Causes of Liver Fibrosis
Various disorders and drugs can repeatedly or continuously damage the liver and thus cause fibrosis (see table Some Conditions and Drugs That Can Cause Fibrosis of the Liver Some Conditions and Drugs That Can Cause Fibrosis of the Liver 
).
The most common causes in the United States are
Nonalcoholic fatty liver Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more (fatty liver not due to alcohol use—nonalcoholic steatohepatitis)
Nonalcoholic fatty liver usually occurs in people who have excess body weight Obesity Obesity is excess body weight. Obesity is influenced by a combination of factors, which usually results in consuming more calories than the body needs. These factors may include physical inactivity... read more 
, diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more or prediabetes, and/or high levels of fats (lipids) and cholesterol Overview of Cholesterol and Lipid Disorders The body needs fats (lipids) for growth and energy. It also uses them to synthesize hormones and other substances needed for the body’s activities. The body may deposit excess fat in blood vessels... read more in the blood. This combination of risk factors for fatty liver disease is often referred to as metabolic syndrome. Metabolic Syndrome Metabolic syndrome is characterized by a large waist circumference (due to excess abdominal fat), high blood pressure, resistance to the effects of insulin (insulin resistance) or diabetes,... read more Over recent years, metabolic syndrome leading to nonalcoholic fatty liver has become increasingly common in the United States. Worldwide, viral hepatitis B (see table The Hepatitis Viruses) The Hepatitis Viruses is a common cause. Sometimes the cause of fibrosis is not known.
Symptoms of Liver Fibrosis
Fibrosis itself does not cause symptoms. Symptoms may result from the disorder causing fibrosis. Also, if fibrosis progresses, cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more may develop. Cirrhosis can cause complications (such as portal hypertension Symptoms Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches. Cirrhosis (scarring that distorts... read more ) that cause symptoms.
Diagnosis of Liver Fibrosis
A doctor's evaluation
Sometimes blood tests, imaging tests, or both
Sometimes liver biopsy
Doctors suspect fibrosis when people have a disorder or take a drug that could cause fibrosis or when routine blood tests to evaluate the liver Liver Blood Tests Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, viral hepatitis in donated blood) and to measure the severity and progress... read more indicate that the liver is damaged or is malfunctioning. Tests are then done to confirm the diagnosis, and if fibrosis is present, tests are done to determine its severity. These tests can include imaging tests, blood tests, liver biopsy, and sometimes specialized imaging tests to determine how stiff the liver is.
Imaging tests Imaging Tests of the Liver and Gallbladder Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) do not detect early or moderately advanced fibrosis. However, these tests may show abnormalities that can accompany cirrhosis and portal hypertension (such as an enlarged spleen Enlarged Spleen An enlarged spleen is not a disease in itself but the result of an underlying disorder. Many disorders can make the spleen enlarge. Many disorders, including infections, anemias, and cancers... read more or varices Portal Hypertension Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches. Cirrhosis (scarring that distorts... read more ).
Certain combinations of blood tests can distinguish between two levels of fibrosis:
Absent or mild
Moderate to severe
These tests cannot reliably differentiate between degrees of moderate or severe fibrosis. The severity of fibrosis helps indicate the prognosis in people who have chronic viral hepatitis.
Liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more is the most reliable way to detect and stage (determine the amount of) fibrosis and to identify the disorder causing fibrosis. Biopsy is often done to confirm the diagnosis, to identify the cause of the liver disease, to stage the level of fibrosis or the presence of cirrhosis, as well as to assess the response to the treatment. Because liver biopsy is invasive and can cause complications, doctors may first do blood tests and imaging tests to determine the level of fibrosis and then decide about the need for a liver biopsy. Doctors are increasingly relying on certain specialized imaging tests as noninvasive alternatives to biopsy.
Specialized imaging tests can determine how stiff the liver is. The stiffer liver tissue is, the more severe fibrosis is likely to be. These tests (transient elastography, magnetic resonance elastography, and acoustic radiation force impulse imaging) use sound waves, applied to the abdomen, to determine how stiff the liver tissue is. Unlike liver biopsy, these tests are not invasive and thus have some advantage. Transient elastography and magnetic resonance elastography are being used in people with various liver disorders to diagnose and stage the fibrosis. Additionally, these tests are used to assess the amount of liver fat in people with fatty liver disease. Conventional ultrasonography can be unreliable because results depend on the skill of the person doing the procedure. In contrast, these specialized imaging tests report their measurement in numbers, allowing objective assessment.
Treatment of Liver Fibrosis
Doctors focus on treating the cause, which often stops or slows further scarring of the liver and sometimes results in improvement. Such treatment may include
Using antiviral drugs to eliminate the virus if people have chronic viral hepatitis Overview of Chronic Hepatitis Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Common causes include hepatitis B and C viruses and certain drugs. Most people have no symptoms, but some have vague... read more
Using drugs to remove heavy metals if people have iron overload (hemochromatosis Hemochromatosis Hemochromatosis is a hereditary disorder that causes the body to absorb too much iron, causing iron to build up in the body and damage organs. In the United States, over 1 million people have... read more
) or Wilson disease Wilson Disease In Wilson disease, a rare hereditary disorder, the liver does not excrete excess copper into the bile as it normally does, resulting in accumulation of copper in the liver and liver damage.... read more 
(which causes copper to accumulate)Stopping any drug or supplement that is causing fibrosis
Removing or dissolving a blockage in the bile ducts
Losing weight and controlling blood sugar and lipid levels in people with nonalcoholic fatty liver Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more
No available drug stops the formation of scar tissue effectively and safely. However, drugs that may reduce fibrosis are currently under study. Silymarin, in milk thistle Milk Thistle Milk thistle is a purple-flowered plant. Its sap and seeds contain the active ingredient silymarin, a potent antioxidant and a term often used interchangeably with milk thistle. Antioxidants... read more , or coffee may help protect the liver against fibrosis, but the evidence is not enough to recommend either as treatment.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
copper |
No brand name available |
milk thistle |
Milk Thistle XTRA |
