Liver fibrosis symptoms and treatment

Liver fibrosis (AF) is one of the most common complications associated with liver disease. AF manifests itself as sequential proliferation and hardening of connective tissue, leading to inflammation.

Thus, the body tries to create a barrier between the affected area of ​​the body and the healthy one, preventing the infection from spreading. Unfortunately, many people don’t know what fibrosis is.

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When factors affecting the liver occur, biologically active substances are formed that trigger the work of macrophages, which secrete substances that aggravate the anti-inflammatory reaction. The balance is disturbed, which leads to the predominance of the production of fibrotic protein.

The normal exchange between blood and liver cells gets lost, this ultimately leads to liver necrosis. Sometimes the work of mediators of focal inflammation can stop and then the processes aimed at stopping pathological fibrosis and restoring the normal functioning of the body are activated.

Causes of liver fibrosis

A number of factors lead to this complication:

  • viral lesions: cytomegalovirus, viral hepatitis and infectious mononucleosis,
  • failure of the immune system,
  • damage to the bile ducts,
  • portal hypertension,
  • Bad-Qiarri syndrome (retention of venous blood in the liver),
  • abuse of alcoholic beverages for 7 years or more (alcoholic liver fibrosis develops),
  • genetic conditioning (heredity),
  • medicinal substances: anti-cancer drugs, antirheumatic drugs, vitamin A.

Acquired fibrosis

The acquired form occurs during the course of toxic hepatitis caused by exposure to chemicals, poisons and toxins that affect hepatocytes. Sometimes connective tissue begins to grow as a result of bile retention, antibiotics and other powerful drugs.

The risk group includes people working in hazardous industrial production.

Congenital fibrosis

Congenital liver fibrosis (fibrocholangiocystosis, cystic fibrosis or cystic fibrosis) is a genetically determined pathology, expressed by a morphological disorder of the intrahepatic branches of the portal vein and biliary tract. The clinic is characterized by portal hypertension with bleeding in the digestive system.

Fibrocholangiocystosis is expressed by fibrotic changes in the liver and outgrowth of cysts in the intrahepatic bile ducts. This disease is quite rare, but it can occur against the background of nephronophthisis, polycystic or dysplasia. Pathology is not confined to gender. The prognosis of the disease depends on its form, it can be both favorable and fatal.

Symptoms and first signs

The disease often develops asymptomatically at first. Symptoms begin to appear already at a long stage. There are no clinical signs at the first stages, the proliferation of connective tissues can be detected by analyzing a piece of organ tissue.

The early manifestations of this pathology include the following non-specific symptoms:

  • decrease in working capacity,
  • increased fatigue,
  • the appearance of difficulties during physical and psychological stress.

These signs may indicate other complications.

With fibrosis, the following specific symptoms will appear further:

  • anemia,
  • deterioration of immunity,
  • bruising all over the body,
  • bleeding in enlarged veins of the digestive system,
  • the formation of vascular cobwebs.

The symptoms of liver fibrosis in children are the same as in adults.


The classification of the pathology under consideration is divided into two types.

The first is based on the causes of the disease. Experts distinguish three forms:

  • cardiac fibrosis of the liver,
  • periportal fibrosis of the liver (develops due to parasitic infection),
  • hereditary form (this is the result of metabolic disorders caused by excessive stagnation of chemicals in tissues and organs, develops against the background of polycystic renal disease).

Another classification is based on the distribution and localization of tissue growths:

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  • periductal form (concentration of fibrous segments around the bile ducts),
  • pericellular form (damage to the surface of hepatocytes, the formation of impenetrable membranes around them),
  • mixed form (combines several features of various forms at once),
  • venular and perivenular form (damage to the median tissue of the hepatic lobules),
  • septal form (the appearance of extensive necrosis).

Stages of liver fibrosis

To establish the stage of organ destruction, liver biopsy is used as an instrumental method or fibrotest. The results are interpreted according to the METAVIR method.

In accordance with these methods, specialists distinguish 4 stages of AF. To determine the degree of liver fibrosis, a scale with positions from 1 to 4 is used.

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1 degree

With liver fibrosis of 1 degree, the organ has lost its full functioning, there is a violation of the exchange between hepatocytes and blood cells. With rapid diagnosis and quality treatment, the disease recedes.

2 degree

Liver fibrosis of the 2nd degree is established with an increase in the area of ​​changes and organ damage. Therapy becomes more complicated, the disease is difficult to contain with drugs at this stage, and then fibrosis of the 2nd degree turns into AF of the third stage.

3 degree

Grade 3 liver fibrosis consists in the formation of seals in the structures of the organ. Without careful treatment, the prognosis becomes negative – the pathology enters the final stage.

4 degree

Grade 4 liver fibrosis is diagnosed when cirrhosis occurs. It is possible to defeat him only with an organ transplant.


The degree of liver health in medicine is determined by the Metavir scale. It is optimal and helps to interpret the results of fibrotest, analysis for alt and asth or biopsy, which is the most reliable option for diagnosing various diseases.

While examining a tissue fragment, METAVIR assigns two base numbers: the first to determine the degree of inflammation, the second to represent the degree of fibrosis, which is set on a scale from 0 to 4. The level of necrotic and inflammatory processes is assessed on a 4-point scale.


The indicator of the intensity and activity of pathology is indicated in the form of a two-letter and two-digit system. For example “F2-A3”, “F3-A1”, that is, almost any combination from the list of correspondences on the metavir scale is possible:

  • f0 (no fibrosis) – a0 (no activity),
  • f1 (portal tissue proliferation without septa) – a1 (moderate activity),
  • f2 (portal tissue proliferation with several septa) – a2 (medium activity),
  • f3 (portal tissue proliferation with many septa) – a3 (high activity),
  • f4 (cirrhosis).

Other scales

In addition to the METAVIR index, the stages of liver fibrosis can be determined using the Knodel and Iskhak scales, which were originally invented to determine the degree of liver fibrosis in hepatitis.

The level of hepatitis intensity is assessed by the Knodel system. It is more complicated than METAVIR, but it is characterized by a higher accuracy for establishing the severity of the inflammatory process accompanying liver fibrosis in hepatitis C.

The method is based on the use of four different points that together make up the overall index. The first block of the index (periportal necrosis) ranges from zero to ten. The next two blocks (lobular necrosis and portal inflammation) range from zero to four.

The combination of these three components determines the level of the inflammatory process:

  • 0 (no inflammation),
  • 1-4 (beginning of inflammation),
  • 5-8 (slight inflammation),
  • 9-12 (moderate inflammation),
  • 13-18 (severe inflammation).

The fourth block indicates the level of organ hardening and varies from 0 (no scars) to 4 (cirrhosis).

Stages of liver fibrosis on the Ishak scale:

  • 0 – no fibrosis,
  • 1 – fibrosis grows into several portal pathways,
  • 2 – fibrosis spreads to most of the portal pathways,
  • 3 – fibrosis spreads to many portal tracts and some portoportal septa,
  • 4 – fibrosis covers the portal tract and many portoportal and portocentral septa,
  • 5 – incomplete cirrhosis,
  • 6 – full-fledged cirrhosis.

Methods of diagnosis

At the initial stage, the disease is difficult to identify due to the fact that the signs of liver fibrosis are nonspecific. For a long period of time, fibrotic changes occur without visible symptoms.

The diagnosis of liver fibrosis has several methods. The most common is a laboratory one, based on the following tests: general blood test, analysis for alt and ast, blood biochemistry, fibromax, general analysis of urine and feces.

The second group of methods is instrumental. Based on the following procedures:

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  • Ultrasound.
  • Fine needle biopsy.
  • Esophagogastroduodenoscopy.
  • CT scan.
  • Biopsy.
  • Fibrotest.
  • Fibroscanning.
  • Indirect Elastometry.

Many are interested in whether AF is visible on ultrasound of the liver. Experts say that it is visible, and therefore this method is the fastest and easiest in the initial diagnosis, moreover, everyone knows what it is, in contrast to biopsy or elastometry.


Before treatment, it is necessary to eliminate other problems of the body, if any (destroy viruses, bacteria and parasites in other organs). Next, you need to get rid of the effects of household and industrial toxic substances. Eliminate the use of certain drugs that have an adverse effect on hepatocytes (sedatives, preservatives and steroids).

The initial treatment of liver fibrosis after diagnosis is with medication. Medications containing ursodeoxycholic acid affect the reduction of inflammatory processes and the maintenance of liver function. The attending physician also prescribes the latest drugs that inhibit the proliferation of connective tissue.

Compliance with a certain diet, the diet of which is based on nutrition with a maximum reduction in the load on the liver, has a significant impact on the healing process. A diet for liver fibrosis is prescribed by a doctor and the patient must eat strictly according to it.

Traditional medicines

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Many are interested in: is it possible to cure such a serious disease with folk remedies? Experts have figured out how to treat AF with alternative medicine.

The pathology under consideration requires a complex effect, and the organic substances of many medicinal plants can have a beneficial effect on the work of hepatocytes and reduce the intensity of the inflammatory reaction.

Milk thistle, white cinquefoil, chicken eggs, blueheads, birch leaves, half-fallen, dandelion, infusions of buckthorn, prunes, rose hips, apple cider vinegar and honey will help to treat liver fibrosis, reducing the unfavorable course of the disease.

Fibrosis progression

The intensity of progression of fibrosis differs significantly in different patients. It occurs most rapidly in adult male patients with weak immunity, who often drink alcohol. Also diabetes and excess weight contribute to its development.

At the moment, there is no accurate method for predicting the rate of progression of necrosis in patients. A large amount of alanine aminotransferase in the blood can serve as a marker. ALT and AST analysis, fibrotest, ultrasound fibroscan examination and biopsy can also help in predicting the development of events.

Life expectancy with fibrosis

It is important to know how long people with AF live. Before cirrhosis, the disease is not life-threatening with proper treatment. After the onset of the fifth stage, many factors affect life expectancy. Sometimes the patient lives for more than ten years, and in other cases it may not last even a year, dying of cirrhosis.

The situation is influenced by: the degree of compensation of liver function, etiology, blood biochemistry, complications of cirrhosis, quality of therapy, concomitant problems, nutrition, gender and age of the patient.

With timely diagnosis, you can significantly reduce the rate of development of the fifth stage and live with it for ten years.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.