In collaboration with Liver4Life
Knowing the difference between cirrhosis and fibrosis is important. It will give you a clear understanding of where you are in the journey of managing your liver health. Both conditions are as a result of damage to the liver. My Liver Exam helps you to understand these two stages.
First, a short video to understand the main issues regarding liver fibrosis :
Liver damage follows a clear path, illustrated below:
Early fibrosis offers a warning sign that something needs to be addressed to improve the health of your liver. Whereas a diagnosis of significant fibrosis or cirrhosis can mean that urgent attention and medical action is required.
What is fibrosis?
Fibrosis is the term used to describe mild scarring in the liver. Fibrosis occurs when the liver is repeatedly or continuously damaged or inflammed1. It is a condition that can be reversed if spotted in the early stages and steps are taken to prevent further damage.
Identifying and dealing with the cause can usually achieve reversal of early fibrosis.
If damage is repeated or continuous (as occurs in chronic hepatitis), liver cells will attempt to repair themselves, but the attempts may result in scar tissue1. This continuous cycle, over a period of months and years, may cause more significant, advanced fibrosis and proceed to cirrhosis.
Why can fibrosis have a negative impact on your liver?
Scar tissue replaces liver cells, however it has no useful function. Scar tissue can interfere and prevent blood flow to and within the liver, limiting the blood supply for the liver cells2.
This lack of blood flow can cause liver cells to die, causing a knock-on effect where more scar tissue is formed2. Also, due to the lack of available places for the blood to go, it causes increased pressure in the vein that carries blood from the intestine to the liver (portal vein) — this condition is called portal hypertension (this usually occurs in the cirrhosis phase2).
It is worth noting that fibrosis can develop more rapidly when it is caused by a blockage in the bile ducts – this is the case with conditions such as Primary biliary cholangitis/cirrhosis (PBC) and Primary sclerosing cholangitis (PSC). Also worth noting is that a single episode of injury or damage, even if severe, does not usually cause fibrosis2. The damage has to be sustained over a period of time for it to have an impact on liver health.
Fibrosis can sometimes be reversed if the cause is identified promptly and corrected2. However, after months, or years, of repeated or continual damage, fibrosis can develop. The scar tissue can be found throughout the mass of the liver, destroying the liver’s internal structure and affecting the liver’s ability to regenerate itself and function. Such severe scarring is called cirrhosis2.
What can be the diagnosis for cirrhosis?
Cirrhosis has traditionally been thought of as a permanent condition where the damage done is irreversible. Although a serious condition, recent research indicates that cirrhosis can be reversed in cases where the underlying cause can be successfully treated3 to some extent. Novel therapeutic strategies are under investigation to target specific steps in the process of ‘fibrogenesis’ with the aim of reversing advanced fibrosis/cirrhosis.4
As previously mentioned, portal hypertension can be one of the earliest and most important consequences of cirrhosis. Indeed, if cirrhosis is left untreated, portal hypertension can in some case cause severe problems.
What can be the causes of cirrhosis?
Various liver conditions can continuously damage the liver and may cause fibrosis. The most common causes in the UK include alcohol, viral hepatitis and weight-related conditions, such as non-alcohol related fatty liver disease (NAFLD). Other conditions include5:
- Liver related hereditary metabolic disorders (such as haemochromatosis and Wilson’s Disease)5
- Autoimmune disorders (such as PBC, PSC and autoimmune hepatitis)5
- Disorders that affect blood flow to, in, and out of the liver (such as Budd-Chiari syndrome, Heart failure, Portal vein thrombosis)5
- Veno-occlusive disease of the liver (blockage of the small veins in the liver)5
What can be the complications linked to cirrhosis?
This is because the liver is able to function properly despite being damaged. Noticeable problems tend to develop as the liver becomes more damaged. As the condition progresses, symptoms tend to develop when liver functions are affected6, including:
- tiredness and weakness6
- loss of appetite6
- weight loss and muscle wasting6
- feeling sick (nausea) and vomiting6
- tenderness or pain around the liver area6
- tiny red lines (blood capillaries) on the skin above waist level6
- very itchy skin6
- yellowing of the skin and the whites of the eyes (jaundice)
- a tendency to bleed and bruise more easily, such as frequent nosebleeds or bleeding gums6
- hair loss6
- fever and shivering attacks6
- swelling in the legs, ankles and feet caused by a build-up of fluid (oedema)6
- swelling in your tummy (abdomen) caused by a build-up of fluid known as ascites – severe cases can make you look heavily pregnant6
To have a better understanding of cirrhosis complications, feel free to watch this video :
Physicians can often diagnose fibrosis and cirrhosis, estimating its severity based on results of blood and imaging tests, but sometimes a liver biopsy is preferred. Specialist non-invasive tests that measure the stiffness of the liver are being increasingly used by the medical community and are becoming more readily available to patients across the UK. These tests can give a very good indication of the state of the liver and whether fibrosis or cirrhosis is present.
Liver icons ©EstherQueen999
- Ismani; Saudi J Gastroenterol. 2009 Jan; 15(1): 72–79.doi: 10.4103/1319-3767.45072. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702953/ [Accessed: 28 March 2017]
- Civan J.M., MSD Manual. Consumer version. Fibrosis of the Liver. http://www.msdmanuals.com/en-gb/home/liver-and-gallbladder-disorders/fibrosis-and-cirrhosis-of-the-liver/fibrosis-of-the-liver [Accessed 25 April, 2017]
- NHS Choices. Treating cirrhosis. http://www.nhs.uk/Conditions/Cirrhosis/Pages/Treatment.aspx [Accessed 28 March 2017]
- A. A. Sohrabpour; M. Mohamadnejad; R. Malekzadeh. Review Article: The Reversibility of Cirrhosis. Aliment Pharmacol Ther. 2012;36(9):824-832. http://www.medscape.com/viewarticle/772507_1 [Accessed: 28 March 2017]
- Civan J.M., MSD Manual. Consumer version. Fibrosis of the Liver. Table containing Some Conditions and Drugs That Can Cause Fibrosis of the Liver. http://www.msdmanuals.com/en-gb/home/liver-and-gallbladder-disorders/fibrosis-and-cirrhosis-of-the-liver/fibrosis-of-the-liver#v11555896 [Accessed 28 March 2017]
- NHS Choices. Cirrhosis – Symptoms. http://www.nhs.uk/Conditions/Cirrhosis/Pages/Symptoms.aspx [Accessed: 28 March 2017]