Patients who suffer from diseases such as viral or toxic hepatitis, amyloidosis, galactosemia, Wilson-Konovalov syndrome, know firsthand about liver fibrosis. What is it, how to treat this pathology?
Fibrosis cannot be called an independent ailment. Rather, it is a complication that occurs as the above liver diseases progress. What is fibrosis? This is a pathological process in which gland cells are replaced by scar tissue. Due to the spread of fibrous fibers, the liver gradually loses its functionality.
general description
It is difficult for people far from medicine to imagine what liver fibrosis is. This disorder occurs in the history of almost all patients with chronic diseases of the hepatobiliary system. Opening the definition of liver fibrosis, attention should be paid to diffuse degeneration of the gland. The process of proliferation itself begins at first in separate parts of the organ, and over time, the disease spreads to all parts of the organ.
Fibrous tissue consists of coarse connective fibers and amorphous substances, so it can not be beneficial for the liver. In some cases, organ degeneration is observed in diseases of the heart, pancreas, and bile ducts.
Provocative factors
Determining the cause of the disease plays a huge role in prescribing the right treatment. Most often, hepatic fibrosis is caused by:
- alcohol addiction;
- hereditary diseases of the hepatobiliary system ;
- autoimmune hepatitis;
- cytomegalovirus infection;
- simple type human herpes virus;
- mononucleosis;
- medicines related to the group of antitumor, antirheumatic, hormonal;
- intense and prolonged exposure to pesticides, toxic substances;
- chronic pathologies of the biliary tract;
- heart diseases, including heart failure;
- venous stasis.
What is liver fibrosis? This is a pathology that does not occur without prerequisites. The process of degeneration of healthy liver tissue into cicatricial starts in the presence of a certain factor, a kind of trigger mechanism. Usually, the disease progresses over several years, gradually moving from one stage to another. However, in medical practice there are many cases where the disease developed rapidly and literally in a few months led to the death of the patient. To accelerate the rate of progression of liver fibrosis is capable of diabetes mellitus, immunodeficiency, and obesity.
Forms of the disease and causes
Answering the question of what is liver fibrosis, one cannot but take into account the classification of this disease. Varieties and forms of the course of the pathology depend on the causes of the degeneration of healthy cells and the localization of focal scar tissue. Liver fibrosis happens:
- Focal. This is a form of the disease that occurs with violations of the blood and blood flow. In this case, the pathology is the result of stagnation or an increase in local intrahepatic pressure.
- Cardiac. This type of pathology is a consequence of serious problems in the cardiovascular system. Depending on the site of damage to the liver tissue, cardiac fibrosis is focal, zonal and extensive.
- Periportal. The risk of this type of fibrosis increases with increased venous pressure in the gland. As a rule, this pathology is a complication of advanced helminthiasis.
- Inherited. In this case, a person is born with liver fibrosis, but the disease does not always make itself felt.
Based on the localization of organ damage, several forms of pathology are distinguished. If the fibrous process proceeds in the central lobes of the liver, we are talking about venular and prevenular forms. Pericellular fibrosis is characterized by the growth of scar tissue around healthy liver cells, which are clad in a rough shell. If the lesions are located near the bile ducts, they speak of a periductal form of the disease. Septal fibrosis is accompanied by extensive necrosis of hepatocytes. There is also a mixed species that combines all the features of previous species.
Stages of Hepatic Fibrosis
The treatment tactics and prognosis for the patient largely depends on at what stage of development an ailment is detected. So how many degrees of liver fibrosis? Get the answer to this question will help the Metavir scale - a special technique that hepatologists use in their professional activities. Specialists distinguish several degrees of liver fibrosis:
- 0 degree (F0) - according to the results of analyzes, there are no obvious signs of pathology.
- Liver fibrosis of the 1st degree (F1). For this stage, the appearance of small connective tissue nodes is typical, the first signs of a metabolic malfunction between hepatocytes and blood cells.
- Liver fibrosis of the 2nd degree (F2). The area of the lesion of the gland continues to increase, an expansion of portal tracts is observed, changes in the structure of the organ are noticeable.
- Liver fibrosis of the 3rd degree (F3). An enlargement of the organ in size is felt during palpation, during the ultrasound examination you can see many fibrous lesions.
- Fibrosis of the liver 4 degrees (F4). Scar tissue at the last stage extends to the entire organ, irreversible processes are launched, so the risk of death increases.
How to recognize the disease, by what symptoms
The fibrous process is slow. Moreover, even with the third and fourth degrees of liver fibrosis, the symptoms sometimes appear, then subside. In total, from the beginning of the degeneration of the organ to the manifestation of the first symptomatology, 5-7 years can pass. The latent period of the course of the disease - this is the insidiousness of hepatic fibrosis. It is in the initial stages that the patient has every chance to undergo effective treatment and restore the affected gland.
And yet there are symptoms of liver fibrosis, which manifest themselves at the zero and first stages. Few people pay attention to them, since they are typical of most of the most common diseases. These include:
- constant fatigue;
- drowsiness, lethargy;
- apathy;
- the appearance of bruises on the body at the slightest blow;
- decreased performance.
All of these signs indicate health problems. Their appearance is an occasion to visit a doctor and take tests. If the patient has a history of any type of hepatitis, he will automatically be at risk of developing fibrosis. Yellowing of the sclera of the eyes, skin, pain on the right side under the rib can also be considered indirect signs of the disease.
With liver fibrosis of degrees 2 and 3, much more specific symptoms appear that indicate a diagnosis. The patient has the following symptoms:
- anemia;
- weakened immunity;
- an increase in the size of the liver and spleen;
- vomiting with blood;
- digestive disorders;
- loss of appetite and sudden weight loss.
Is there a pathology in children
As already noted, sometimes children are born with signs of hepatic fibrosis. The congenital form of the disease is inherited from parents, but may not manifest itself for many years. Usually, symptoms of liver fibrosis in children are manifested in serious malfunctions of the immune system. It is most often possible to diagnose the disease by the age of the liver and kidneys that are inappropriate for the age, the presence of cystic neoplasms throughout the body. In addition, a child with fibrosis may experience persistent hypertension.
To make a prediction about the life expectancy of a child with congenital liver lesions, the general condition of the body is taken into account. If the disease has not caused the baby significant damage during the period of fetal development, the chances of healing are high.
Medical examination
If you suspect liver fibrosis (what it is and how to treat it, learn from this article), a number of research procedures will be required. First of all, the doctor should:
- analyze the living conditions of the patient;
- Get an idea of the general state of his health, including the presence of genetic and hereditary diseases;
- listen to all complaints and a detailed description of the symptoms;
- conduct an examination, palpate the patient’s stomach.
If palpation is noted pain in the liver, which may be associated with the development of intoxication as a result of damage to a significant part of the organ, the patient is sent for laboratory tests.
If there are problems with the liver, the patient develops anemia, indicating a lack of iron. A direct marker of fibrosis is the ratio of AST to ALT in excess of one. Also, the patient will have to pass urine and feces.
To confirm the diagnosis, instrumental research methods are used. These include:
- Ultrasound of the abdominal cavity;
- CT or MRI of the liver (varicose veins of the anterior wall of an organ are also considered a sign of fibrosis);
- biopsy.
The last diagnostic procedure will help doctors not only accurately determine the degree of fibrosis, but also to exclude a malignant tumor.
Liver treatment, medication
After the patient is diagnosed accurately and the degree of the disease is determined, the doctor will select the appropriate treatment regimen for hepatic fibrosis. Specialists prescribe a medical course and diet. If the patient needs urgent adjustment of his lifestyle, he will be given appropriate recommendations. In the later stages, treatment of liver fibrosis is rarely complete without surgery.
In order for drug therapy of the disease to lead to positive changes, it is first necessary to deal with the cause of the growth of scar tissue. Once it is eliminated, you can begin to restore the structure and functionality of the organ. With liver fibrosis, patients are prescribed drugs of the following groups:
- hepatoprotectors - drugs that protect healthy liver cells, help them maintain their viability;
- glucocorticosteroids - necessary to relieve general inflammation;
- cytostatic drugs that slow down tissue replacement processes;
- immunostimulating drugs - activate the body's defenses to combat pathology;
- choleretic tablets that prevent stagnation of bile;
- diuretics to remove excess fluid from the abdominal cavity;
- painkillers;
- antioxidants that neutralize the effects of toxins;
- enzymes that promote the digestion of food.
If fibrosis develops against a background of a viral infection, antiviral agents must be prescribed. For patients who abuse alcohol, a prerequisite is the rejection of alcohol. In the future, the treatment plan is adjusted by the doctor individually. The choice of treatment tactics depends on which factor provoked the disease, at what stage the patient sought help.
Surgery for liver fibrosis
Is it possible to cure this disease with medication alone? In uncomplicated cases - yes, in severe cases, surgery will be required. Indications for surgical intervention are:
- schistosomiasis (a type of helminthiasis caused by flatworm schistosomes);
- internal bleeding;
- hypersplenism;
- cirrhosis.
Before deciding on a radical method of treatment, the doctor must make sure that the conservative therapy is ineffective. A contraindication to surgery is pregnancy. In some cases, the operation is carried out by laparoscopic method. If a patient has cirrhosis, the only thing that can save his life is a liver transplant. Organ transplantation is a very complex and expensive process, therefore, most often their close relatives become donors for patients. In this case, the chances of rejecting the new organ are much lower. According to some reports, most people who have had a liver transplant surpass the ten-year survival threshold if they lead a healthy lifestyle, eat well, and undergo regular examinations.
Nutrition rules
A diet for liver diseases should not deprive the patient of the opportunity to receive all the necessary nutrients. The diet recommended by doctors is balanced, although it implies some limitations. Patients with liver fibrosis are prescribed diet No. 5. The following principles are the basis of such nutrition:
- minimum intake of fats and carbohydrates;
- optimal cooking methods include baking, stewing, cooking;
- ban on spicy, smoked, fried, salty foods;
- at least five meals a day;
- fractional servings;
- drinking at least 2 liters of fluid daily;
- moderate temperature of food intake;
- refusal of coffee, black tea, alcohol.
In the last stages of liver fibrosis, patients are prescribed a more strict diet. Moreover, nutrition recommendations are compiled by the doctor individually for each patient. The daily diet is compiled by a nutritionist individually. In addition to the above limitations, patients are not allowed to consume foods that increase the production of gastric juice, containing crude fiber, acids, and purines.
Folk therapy
In the fight against such a serious and dangerous disease, decoctions and infusions of herbs can hardly be called effective. However, folk remedies can be a good addition to the main treatment program. Using natural compounds in combination with medicines, you can achieve good results in treatment by removing inflammation and restoring the cells of the affected organ.
With the growth of fibrous tissue, milk thistle will help. This medicinal plant has a powerful hepatoprotective effect, helping to normalize liver function and restore damaged cells. For the treatment of fibrosis, it is advisable to use milk thistle seeds, having previously crushed them into powder. Take the mixture twice a day for 1-2 tablespoons. If the powder seems unpleasant to taste, it can be washed down with green tea, kefir, juice.
White cinquefoil also helps against fibrosis. This plant prevents the further spread of connective scar tissue and contributes to the gradual restoration of the normal structure of the liver. For treatment, rhizomes of the cinquefoil are used, from which alcohol tincture is prepared. 50 g of dry raw materials require half a liter of vodka. The medicine is insisted in a dark, non-hot place for three weeks. After this period, the tincture is considered ready for use. With liver fibrosis, 30 drops of tincture diluted in 50 milliliters of water are taken three times a day for 10 days.
We offer you to familiarize yourself with another simple recipe that is used for many liver diseases, including fibrosis. For cooking, you will need three main components: prunes (200 g), rosehip extract (50 ml) and buckthorn bark (1 tbsp. L.). The mixture is poured with hot water and brought to a boil over low heat. Ready broth is taken before bedtime, 100 ml.
What complications may arise
Most often, the cause of the negative consequences of the disease is an untimely start of treatment or a medical error, that is, an incorrect diagnosis. The risk of complications increases if the patient partially or completely ignores medical instructions. The most common consequences of hepatic fibrosis are:
- arterial hypertension;
- varicose veins of the liver and internal organs, accompanied by frequent bleeding;
- the so-called hepato-pulmonary syndrome, the cause of which is oxygen deficiency in the liver cells;
- ascites (accumulation of fluid in the abdominal cavity);
- peritonitis;
- chronic liver failure;
- disorders in the gastrointestinal tract;
- malignant liver formations;
- cirrhosis.
Doctor's recommendations for the prevention of fibrosis
In order to prevent the process of tissue degeneration, it is important to follow a few simple rules:
- Change adverse environmental conditions, hard work with harmful working conditions.
- Never self-medicate, do not take medicine on the advice of friends, relatives, acquaintances, etc.
- Revise the diet: it should include only healthy food.
- Stop smoking, drink alcohol.
- Avoid stress, anxiety, frustration.
- Annually undergo examination, preventive medical examinations.
- Do not leave untreated diseases such as gastritis, cholecystitis, pancreatitis, hepatitis.
- It is full time to relax, more often to be in the fresh air and lead an active lifestyle.
- Strengthen the immune system.
What is the prognosis given to patients with liver fibrosis? Studies show good results. Most likely to defeat the disease are those people who in time sought medical help in the initial stages. Moreover, third-degree fibrosis does not always give a positive result and only in isolated cases leads to recovery, but despite this, a number of measures can be taken to improve the patient's condition and quality of life. The terminal stage of fibrosis is characterized by high mortality. Patients can be helped at this stage of the disease only by liver transplantation.