Liver Awareness Month: Fibrosis

Let’s Stop the Progression of Liver Disease

Last week, in our hepatitis blog post, we reviewed the role of inflammation in the liver and what happens when someone has liver disease and develops hepatitis. If you missed it, read it here.

As a refresher, inflammation occurs when a healthy liver is hard at work destroying toxins or invaders and repairing damaged cells. Damaged liver cells and immune cells both send out messages to activate specific repair cells which travel to the site of the injury. These repair cells release something called collagen, a fiber, which stiffens the tissue around the cells, protects the surviving cells, and allows healing to occur. In a healthy liver, this repair process is very closely regulated and, when no longer needed the extra collagen will disperse and the liver returns to normal.

When someone has liver disease, their liver enters into a very dangerous cycle. Persistent inflammation, or hepatitis, sends nonstop signals to the repair cells to continue depositing collagen. The extra collagen stiffens around the tissue like it is supposed to in the healthy liver; but, instead of a signal being released to stop the inflammation and discard the extra collagen, the inflammation continues, and even more collagen is deposited, leading to more stiffening. This is how fibrosis develops.

When repetitive damage or long-lasting inflammation occurs, collagen and other proteins build-up between liver cells, forming scar tissue. Scar tissue can block or limit blood flow within the liver, starving and killing healthy liver cells, causing more scar tissue to form. Unlike healthy liver cells, scar tissue cannot function or repair itself. As fibrosis advances it can impact the liver’s ability to function, limit its ability repair itself, and restrict blood flow. Over time, the scars in the liver will continue to build and replace healthy tissue. Gradually, the scars snake out further, covering more of the healthy liver and grow together, or bridge, creating septa or bands of scar tissue. Fibrosis also restricts blood flow; when a doctor wants to determine how severe the scarring is, they examine the impact on the portal blood flow (the portal vein brings all the blood from the intestines to the liver to be processed).

Fibrosis in mild to moderate stages often does not cause symptoms. Due to a lack of symptoms, many people live with liver damage, or fibrosis, without being diagnosed until they have symptoms of cirrhosis. Fibrosis can be reversed if detected early enough and the underlying liver disease that caused the development of fibrosis can be cured or treated. If fibrosis is left untreated, it can lead to cirrhosis and liver cancer. It is important to remember that the process of fibrosis progressing to cirrhosis happens over a long period of time. The time it takes for fibrosis to progress is different for every disease and every person. Not everyone who develops fibrosis will progress to cirrhosis. Not everyone who gets cirrhosis will get cancer.

If you have been diagnosed with liver disease, it is important to know the stage of your liver damage. Knowing the stage of your liver disease will impact the decisions you and your care team make about your health. People with more advanced fibrosis or cirrhosis will need to receive surveillance for liver cancer, may need to avoid certain medications, and may need to be seen by their doctor more frequently for blood tests. There are several tests that can diagnose liver damage. There are also a few scoring systems used. Learn more about them below.

American Liver Foundation is solely responsible for this content, which is made possible through generous support from Mallinckrodt and Salix.