Liver fibrosis: causes, degrees, diagnosis, treatment and prognosis

Liver fibrosis is a proliferation of connective tissue of a pathological nature, not accompanied by a change in the structure of the organ. It differs from cirrhosis in that the hepatic lobules continue to function, since structural changes in them do not occur. However, this is still a serious disease, fraught with consequences.

What are the causes of its occurrence? How does it develop? How is it diagnosed? What is needed to treat it? This and much more will now be discussed.

Pathogenesis

Liver fibrosis is not an independent disease. As a rule, it is formed due to other pathologies that in one way or another affected the liver structures.

Fibrosis is a compensatory process. In its course, damaged liver tissue is replaced by cicatricial. This pathology occurs against the background of almost all liver diseases. And it is accompanied by a progressive slow destruction of this organ.

Over time, the so-called parenchymal densification and further tissue remodeling are formed. First, this leads to inhibition of hepatic functions, and then to their complete loss.

These complications are due to the fact that fibrous tissue does not have the ability to function. So with fibrosis, the cells that fill the organ are replaced by pathological structures.

This occurs due to exposure to the liver of parasitic microorganisms or any chemicals (drugs, alcohol, toxins). All this leads to the formation of an accumulation of fibrous tissues, which, in the end, replace normal cells. This is precisely the “start” from which the disease begins to develop.

Causes

There are many factors that can lead to the development of symptoms of liver fibrosis. These include:

• Excessive consumption of alcohol for 7-8 years.
• Hepatitis having a viral origin (D, C, B). Against their background, acute lesions of the liver tissue of an inflammatory nature often develop.
• Hereditary factor. If the next of kin has or has had fibrosis, then he is prone to the appearance of this pathology.
• Malfunctions in the immune system. Lesions of the bile flow, for example. Or autoimmune hepatitis, in which immune cells destroy their own liver cells.
• Viral pathology. Mononucleosis, for example, or a cytomegalovirus infection.
• Hepatitis toxic origin. Accompanied by liver damage by poisons, chemicals and toxic substances.
• Hypertensive disease, having a portal form.
• Pathology of the biliary tract. They are dangerous in themselves, and also entail consequences.
• Taking drugs with hepatotropic effects. These are drugs prescribed for the fight against tumor formations.
• Venous congestion.
• Pathologies due to genetics. For example, Wilson-Konovalov disease.

As you can see, there are many provocative factors. Therefore, in order to prescribe the correct treatment, you need to conduct a detailed diagnosis to identify the etiology. Since, acting only on the symptoms, the result cannot be achieved.

General clinical picture

Briefly lists the symptoms of liver fibrosis. The disease develops slowly, and at first the patient has no complaints. Nevertheless, it manifests itself. The first sign is regular unreasonable fatigue. And then the following signs begin to appear:

• Violation of the work of organs.
• Impaired circulation.
• General malaise.
• The appearance of bruises even after a slight physical impact on the skin.

Within 6-8 years, the liver is destroyed. And then the disease makes itself felt. This is manifested in critical symptoms. And in which ones:

• Problems in the functioning of the liver. This is due to the fact that the cells of the scar tissue grow significantly, as a result of which they close.
• Enlarged spleen.
• Varicose veins of the esophagus are often accompanied by bleeding from them.
• Anemia, leukopenia and thrombocytopenia.
• Increased portal and splenic pressure.
• The onset or disappearance of ascites (fluid accumulation in the abdominal cavity).
• Digestive problems and heaviness in the hypochondrium.
• Skin rash and itching.
• Dyspnea. Over time, it intensifies. May be accompanied by dry cough.
• Superficial rapid breathing, chest pain.
• The appearance of bluish skin color (cyanosis).
• Heart failure and frequent bronchitis.
• Focal fibrosis of the breast or uterus in women.

In addition, against the background of the disease in question, fibrosis of the heart, aortic valve, pancreas and prostate can develop. And these pathologies already have their consequences.

Types of disease

There are several of them, and all of them depend on the prevalence of the pathological process and its type. The following types of liver fibrosis are distinguished:

• Focal (local). This is a limited process that provokes the appearance of only single foci. This variety, as a rule, is attributed to the first degree of liver fibrosis.
• Diffuse. It is diagnosed at the last stages of the development of the disease - when the pathological process spreads to a large volume of tissues.
• Perihepatocellular. Usually due to alcoholic lesions, syphilis and hypervitaminosis A.
• Zonal. It is characterized by a cylindrical expansion of the portal fields.
• Multibular. In this type of pathology, false lobules include segments of the liver. For this reason, the central veins and portal tracts are noticeable in them.
• Bridge-like. It is characterized by the formation of connective tissue septa (septa) between the hepatic vessels.
• Reductual. With this form of the disease, proliferation of connective tissue is observed along large ducts.
• Periportal. In this case, fibrotic tissue is deposited in the center of the classic lobules of the liver. That is where the central vein is located.

It is also worth noting the attention of cystic fibrosis. This is a separate disease. It is associated with metabolic disorders. In people who are exposed to it, the discharge from organs with glandular tissue has an excessively thick consistency. This leads to the fact that the tubules of the glands become clogged, and as a result a cyst appears.

First degree

Now you can talk in more detail about how the disease in question develops. The first degree of liver fibrosis is most often not characterized by any symptoms. The patient may not complain not for months, but for years.

Morphologically, the disease manifests itself in the destruction of portal tracts. Normal tissue is replaced by connective cords, but septa do not form.

At the first degree, the following symptoms can also be observed:

• Emotional lability (instability in mood).
• Irritability.
• Trouble sleeping.
• Distraction.
• Increased fatigue.
• Apathy.
• Significant decrease in performance.
• As if from nowhere appeared hematomas and bleeding.
• Anemia.
• Increased susceptibility to infections.
• Reduced cellular immunity.

Even the first degree of the disease is cause for concern. Its presence means that an irreversible process occurs in the human body, accompanied by the destruction of the liver.

The problem is that they diagnose the first stage very rarely, since the patient has no complaints, which means that there is no reason to consult a doctor. The presence of the disease can usually be determined by chance. As part of a routine survey, for example.

Second degree

Liver fibrosis proceeds to this stage 4 years after the start of its formation. During all this time, hepatocytes (parenchyma cells) die, which leads to deterioration in the liver and in the performance of its basic functions.

At the second stage of the disease, these signs of liver fibrosis make themselves felt:

• Enlarged spleen in size.
• Esophagus bleeding.
• An increase in the size of the liver.
• The appearance of thrombocytopenia. It is characterized by a decrease in the number of platelets in the blood. The level is less than 150 * 10 ⁹ / l. Alarming signs indicating this: increased bleeding and problems associated with stopping bleeding.

To the second degree, pathology can develop even longer than four years. But if a person regularly suffers from infectious diseases, then less time will be required. Each blow to immunity only accelerates the formation of thrombosis in the liver vessels and the formation of sclerotic changes.

Third degree

In the first and second degree with liver fibrosis, the prognosis is almost always positive. But when the disease goes into the third stage, then the changes in the body, stop and reverse it becomes impossible. Because most of the liver cells are already replaced by scar tissue. Only complex therapy will help here, it can prevent the transition of the disease to the fourth stage.

If we talk about symptoms, then with the third degree, these signs begin to manifest themselves:

• Loss of appetite.
• Nausea and even vomiting. Manifested in the event that a person eats improperly - consumes alcohol, marinades, smoked meats and fatty, spicy, fried foods.
• Dyspeptic symptoms. These include upset stools, heartburn, bloating, rumbling, belching, and flatulence.
• Not passing pain in the right hypochondrium and a feeling of heaviness. The degree of intensity can be different, as well as the nature of the sensations. Patients may complain of aching and pulling pains, as well as sharp and unbearable.
• Headaches, itchy skin.
• Signs of intoxication associated with the fact that the liver, over time, ceases to perform its filtering functions. As a result, toxic products accumulate in the blood.
• Swelling of the extremities, manifesting itself closer to the evening.
• Bleeding gums and nose.
• Increase in body temperature to 37.5 ° C. This indicator can hold for a long time.

In addition to the above, urine darkening is often observed. It becomes the color of a dark beer. This is due to an excess of bilirubin, as well as its decay products.

The lipid metabolism in the tissues is still disturbed, as a result of which the accumulation of deposits of fatty acids and cholesterol begins. As a result, xanthomas are formed - oval nodules under the skin of the soles, palms and eyelids. Still accumulating fluid in the abdominal cavity.

Fourth degree

This is the last stage of liver fibrosis, the fourth. At this stage, the body almost completely loses its functions and the ability to neutralize toxic substances.

The latter are carried through the bloodstream throughout the body, exerting a negative effect on brain cells and the nervous system. That is why in the last stage of fibrosis, mental disorders usually occur. Their presence is indicated by:

• Emotional instability.
• Depression.
• The emergence of unreasonable fears.
• Tendency to depression.
• Inhibition.
• Increased anxiety.
• Memory problems.
• Impaired attention span.
• Loss of ability to absorb new information.

At this stage of liver fibrosis, the prognosis is very sad. The disease progresses irrevocably, and as a result, the following problems appear:

• Pain in the right hypochondrium is accompanied by a feeling of heaviness and colic.
• Blood appears in the vomit.
• There is skin itching, provoked by accumulated bile.
• Dramatically reduced weight. Even with proper nutrition, severe exhaustion occurs.
• Significantly reduced muscle tone.
• The skin is flaky and acquire a bright yellow tint.
• Xanthelasms appear - formations similar to corns, but having a lipid component (fats).
• The upper phalanx becomes thicker. Around the nails, the skin turns blue.
• The joints hurt and become inflamed.
• In men, breasts are greatly enlarged. Many are faced with impotence.
• Veins expand in the abdomen.
• The body is covered with spider veins. The stronger the disease progresses, the more they become.
• Angiomas form in the corners of the eyes and on the tip of the nose.
• The skin on the heels and palms turns red.
• The language is increasing in size.

Can liver fibrosis be cured at this stage? Theoretically, yes. This stage is cirrhosis. The forecast is unfavorable. Liver transplantation is absolutely necessary. Otherwise, the progression of the disease cannot be stopped. At this stage of fibrosis amid complications, life expectancy in 40% of patients does not exceed 3 years.

Diagnostics

Much has been said above about the symptoms and causes of liver fibrosis. It is also worth briefly discussing by which methods this disease is diagnosed.

So, there are laboratory methods:

• General blood analysis. The study of this biomaterial will reveal the presence of viral hepatitis, determine blood coagulability, erythrocyte sedimentation rate, and also find out the level of leukocytes and hemoglobin.
• Testing for fibrosis markers - PGA index.
• The study of the biochemical composition of blood. It helps to check the functions of the liver and pancreas, as well as determine how much trace elements are in the plasma.
• General analysis of urine and feces, coprogram for clay infestation.
• Research on antimitochondrial, antinuclear and anti-smooth muscle bodies.

Instrumental methods can also be used to detect and analyze liver fibrosis. These include:

• Esophagogastroduodenoscopy (endoscopy). A detailed study of the mucous membrane of the stomach, esophagus and 12 duodenal intestine is implied.
• Ultrasound This procedure is aimed at identifying focal areas on the liver of connective tissue, as well as to identify violations in the kidneys, intestines and bile ducts.
• CT scan. Thanks to this procedure, it is possible to exclude tumor processes. You can also determine the exact location of the lesions.
• Fine needle biopsy. It helps to establish an accurate diagnosis - cirrhosis, fibrosis or oncology.
• Elastometry This is an analogue of a biopsy. A new method for examining the liver. The procedure is carried out by means of the Fibroscan apparatus, it takes only 10 minutes.

After diagnosing liver fibrosis, the doctor makes a prognosis, prescribes treatment, and also gives valuable instructions and recommendations that the patient must follow if he wants to recover.

Treatment

Regardless of how easy the person has fixed the degree of liver fibrosis on the Metavir scale, the doctor prescribes therapy. Even the initial stage can be aggravated and transferred to the second by an incorrect, self-prescribed treatment.

First, you must follow a diet for liver fibrosis. We must abandon everything that contains fats and alcohol. This will aggravate the condition of the body, and the diet, on the contrary, is aimed at its restoration.

You need to actively consume proteins. They contribute to the release of macrophages. It is necessary to add low-fat cottage cheese, beef, chicken eggs, soy, seafood, low-fat fish to your diet. They contain lipotropic substances that help the absorption of vitamins E, K, A.

In addition, it is necessary to consume vegetables and fruits (citrus fruits, in particular) in large quantities and observe the drinking regime. It is advisable to completely abandon salt and sugar in bulk form. And also follow the rule - eat 5-6 times a day in small portions, chew food thoroughly, and plan the last meal no later than 3 hours before bedtime.

What about medicines? Taking medications is prescribed only by a doctor. Typically prescribed are “Tocopherol”, “Ursofalk”, “Interferon”, “Karsil”, “Kipferon”, “Essentiale”, “Ursosan”, “Viferon”, as well as lipoic and ascorbic acid.

You can also try using folk remedies. Fibrosis of the liver cannot be cured by them, but their administration can become concomitant therapy and good prevention. To restore the normal function of the body, you can drink decoctions or infusions of rose hips, corn stigmas and milk thistle three times a day in small portions.

Well, it turned out that there are no nerve endings in the liver tissue. Therefore, she cannot get sick, and many people often learn about fibrosis too late. Therefore, it is strongly recommended that a general examination be performed at least once a year to avoid problems and costly long-term treatment.