Liver Fibrosis

Overview

Liver fibrosis is scarring of the liver that’s usually caused by inflammation due to issues like alcoholism, chronic hepatitis, nonalcoholic fatty liver disease and other conditions.

Liver fibrosis starts when persistent inflammation causes damage to the liver. The body attempts to repair this damage by depositing collagen and other proteins in the injured liver tissue, where it begins to form scar tissue. If liver inflammation and damage continues due to a chronic condition, more and more collagen is deposited in the liver, causing more and more scar tissue to form.

Over time, scar tissue can replace healthy liver tissue to the point it begins to block blood flow through the liver. In addition to preventing the liver from performing vital functions, this can also deprive tissues of oxygen and nutrients, further damaging the liver. If the inflammation inside the liver isn’t reduced for many years, this cycle can eventually cause much of a person’s liver to be replaced by scar tissue.

Many people who suffer from fibrosis are unaware they have the condition, since mild to moderate fibrosis often presents no pain or other symptoms. If detected early enough and the underlying causes of liver inflammation addressed, however, the damage from liver fibrosis can be halted and the underlying conditions that caused it can potentially be addressed.

Without treatment, long-term fibrosis can eventually progress to an advanced form called cirrhosis. According to the National Institutes of Health, in most patients, the progression from fibrosis to cirrhosis usually takes around 15-20 years. Cirrhosis can eventually cause liver failure, in which the liver stops working entirely, or liver cancer. The only treatment for liver failure is a liver transplant.

Why Hoag for Liver Fibrosis Evaluation and Treatment?

Facing fibrosis of the liver, or have health challenges that may put you at risk? Stop worrying and know for sure, at the Hoag Digestive Health Institute. Hoag’s unique Liver Program is the most comprehensive in Orange County, offering advanced diagnosis, next-generation treatment options and groundbreaking approaches to detect and reverse the damage caused by fibrosis.

Ongoing liver damage from fibrosis won’t stop until you take steps to end the inflammation that’s causing it. You might not even know you have it. So don’t wait. Trust Hoag, and get a diagnosis you can count on and the advanced treatment that can get your back on the road to health.

Symptoms and Causes of Fibrosis

Liver fibrosis often causes no pain or other symptoms, even if the disease is very advanced or has become cirrhosis. Symptoms of severe fibrosis or cirrhosis may include:

• Unexplained fatigue
• Unexplained nausea or vomiting
• Loss of appetite
• Unexplained weight loss
• A mild ache or discomfort in the upper-right of the abdomen
• Bleeding or bruising easily
• Unexplained confusion, memory issues or difficulty sleeping
• Edema, which is swelling in the lower legs, ankles or feet
• Ascites, which is swelling of the abdomen due to fluid buildup
• Severe, unexplained itching
• Dark-colored urine
• Jaundice, a condition which can cause yellowing of the eyes and skin
• Portal hypertension, which is elevated blood pressure within the portal vein that carries blood from the digestive organs to the liver. This increase in pressure can be caused by a blockage in blood flow through the liver, including blockages caused by scar tissue due to fibrosis

Risk Factors

There are a number of factors that may increase your risk of developing liver fibrosis. These may include:

• Alcohol abuse
• Nonalcoholic Fatty Liver Disease (NAFLD), which is a condition that can cause fat to build up in your liver, damaging the tissue in a way similar to long-term alcoholism, even in those who drink little to no alcohol
• Chronic Hepatitis C
• Chronic Hepatitis B
• Autoimmune hepatitis, in which the body’s immune system attacks the liver and causes tissue damage
• Having certain inherited conditions, including Wilson disease, hemochromatosis and alpha-1-antitrypsin deficiency
• Long term use or abuse of certain medications, including anabolic steroids, erythromycin, sulfa drugs, over-the-counter painkillers containing acetaminophen and others

Diagnosis and Tests

If you visit a physician for evaluation for fibrosis of the liver, your doctor will likely talk to you about your symptoms, followed by a thorough physical exam. Your doctor will also likely talk to you about your alcohol use, medical conditions you may have, certain medicines you might take and other factors that can impact the liver.

Depending on the outcome of the initial exam, you may be referred for further diagnostic testing. These tests may include:

• Imaging tests, which can show the size, texture, shape and stiffness of the liver (which may indicate scarring). Imaging tests may include:
  • Magnetic Resonance Imaging (MRI)
  • Ultrasound
  • X-rays
  • Computerized tomography (CT) scans
• Biopsy, in which a small sample of liver tissue is removed, usually via a needle passed into the liver through the skin, so it can be examined in a lab. Biopsy is one of the most accurate methods of identifying what’s causing liver inflammation and determining how advanced the fibrosis is.
• Blood testing, including tests for:
  • Abnormal enzyme levels that can indicate liver damage
  • Increased bilirubin, which is created when your body breaks down hemoglobin and can cause jaundice if levels are too highTesting for chronic hepatitis B and C

Advanced diagnosis of fibrosis at Hoag
The scarring associated with fibrosis usually advances with no symptoms or tell-tale signs that might alert you to the condition. That’s why you need a team that’s skilled in the detection and diagnosis of fibrosis, with the advanced imaging techniques to now for sure.

At the Hoag Digestive Health Institute, advanced diagnostics for those facing fibrosis, cirrhosis and chronic liver disease include:

• FibroScan®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring and fibrosis without the side effects and complications of a needle biopsy. Learn more about FibroScan®
• Hepatobiliary iminodiacetic acid (HIDA) scanning, which is an advanced imaging technique which utilizes an injected radioactive tracer to diagnosis issues with the liver, gallbladder and bile ducts
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used to quantify fat deposits that may cause inflammation in the liver.
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the liver and bile ducts for disease, without the use of ionizing radiation
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues.
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease (AKA steatosis) and abnormal iron levels in patients with chronic liver disease.
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting for factors that can degrade or skew magnetic resonance signal intensity

Management and Treatment for Fibrosis

While the search for treatment options is advancing every day, there currently is no way to reverse the tissue damage and scarring caused by liver fibrosis. An emerging class of antifibrotic drugs may change that in coming years, allowing doctors to potentially repair liver damage caused by fibrosis.

For now, with early detection, doctors can help patients take steps to stop the progression of fibrosis, including managing or treating conditions like nonalcoholic fatty liver disease, alcoholism or chronic hepatitis B or C that may have caused the inflammation that led to liver fibrosis.

Your doctor may also suggest that you lose weight or make changes to your diet, including having you stop drinking alcohol, limit your intake of fats or protein and other measures that can stop the cycle of inflammation that causes fibrosis.

Treatment for Alcoholism at Hoag

For those with alcohol addiction that may be contributing to fibrosis, cirrhosis or liver disease, Hoag is here for you. The longest-standing addiction treatment option in Orange County, Hoag Addiction Treatment Centers is an accredited program within the Pickup Family Neurosciences Institute that offers help, hope and healing for people and families facing addiction to alcohol and other drugs. For more information, visit this link, or call (949)764-6883.

Prevention

Ways to reduce your risk of developing fibrosis may include:

• Use alcohol in moderation, and seek treatment for alcohol abuse
• Eat a healthy, balanced diet that’s low in fat
• Maintain a healthy weight, as Nonalcoholic Steatohepatitis (NASH), a condition in which fat accumulates in the liver, causing inflammation and liver damage, is often diagnosed in the overweight or obese
• Get vaccinated against hepatitis B
• Get regular checkups, including blood work that can suggest changes in liver function
• Use supplements, prescription medications and over-the-counter medicines as directed by your doctor, being particularly careful when taking non-steroidal anti-inflammatory drugs such as ibuprofen, aspirin, acetaminophen and other pain medications
• Take steps to manage or treat chronic conditions that can impact liver function, including Type 2 diabetes, high blood pressure and chronic hepatitis B and C