Discovering the 7 Major Causes of Liver Fibrosis

The term cirrhosis, translated from the word Cirrhosis, means the liver is brown, as used by Laennec in 1819. Over time, it was observed that the liver not only had a brown color, but more importantly, the infiltration of fibrous tissue made the liver firm. In 1919, Fiesinger and Albot distinguished between fibrotic and cirrhotic livers.

Liver fibrosis is a spreading fibrosis condition within the liver tissue that disrupts the structure of the liver.

The fibrosis process forms fibrous bands, dividing liver lobules into pseudo-lobules, disrupting circulation through the liver, causing further damage to liver cells, and leading to fibrosis spreading within the liver tissue.

Thus, fibrosis is not a separate disease but a pathological syndrome, the ultimate consequence of the liver cell damage process. Fibrosis involves the combination of the following three injury processes:

• Liver cell damage
• Increased connective tissue synthesis
• Regeneration of liver cells

All three processes interact, making the fibrosis condition increasingly severe.

There are numerous factors causing liver fibrosis such as:

• Virus: Leading viruses causing liver fibrosis include HAV, HBV, HCV, HDV, HEV, HGV
• Bacteria: Two types of bacteria commonly causing chronic inflammation and leading to fibrosis are E.coli and tubercle bacillus
• Parasites: Various parasites like malaria, liver fluke, and worms cause venous congestion in the liver, resulting in fibrosis progression
• Poisoning: Acute liver poisoning (lead, copper, chloroform, carbon tetrachloride) can cause irreversible tissue damage. Chronic poisoning, especially alcohol poisoning, alters liver proteins, leading to fibrosis
• Circulatory disorders: Prolonged blood congestion, cardiovascular diseases due to severe right heart failure obstructing blood flow from the liver back to the veins, causing liver cells to undergo necrosis due to lack of oxygen and eventually developing into fibrosis
• Fatty liver disease: Lack of fat-regulating substances (methionine, choline) disrupts fat metabolism, leading to fibrosis
• Iron overload: A hereditary recessive genetic disease, with products like hemosiderin and hemofuscin accumulating in the body and liver, causing fibrosis
• Medications: Some long-term use medications can have unintended effects, often causing liver fibrosis
• Obesity: One of the high-risk factors leading to liver fibrosis

Throughout history, efforts have been made to classify liver fibrosis appropriately, but no classification method has fully met the needs of diagnosis, prognosis, and treatment. Some authors advocate classification based on causes, but in many cases, determining the exact cause of liver fibrosis is challenging. Other authors rely on clinical symptoms for classification.

Clinically, liver fibrosis is mostly categorized into two main types: Compensated and Decompensated:

• Compensated Liver Fibrosis: The early stage of fibrosis where the fibrotic process is slow, liver function remains good due to minimal damage, and healthy liver cells compensate for the injured part. Clinical symptoms are often unclear and may not manifest externally. Patients usually discover it incidentally through abdominal ultrasound or during examinations for other illnesses
• Decompensated Liver Fibrosis: A more advanced stage where liver cells are significantly damaged, healthy cells can no longer compensate for liver function. Extensive liver damage leads to noticeable functional failure and external symptoms. Most cases of decompensated liver fibrosis exhibit both cirrhosis and portal hypertension syndromes

Liver fibrosis causes dangerous complications that can lead to death, including:

• Ascites, swollen lower limbs: Increased portal vein pressure combined with reduced blood protein causes leg swelling, abdominal distension with fluid retention, yellowish ascitic fluid, and increased risk of bacterial infection. Patients may experience abdominal pain, diarrhea, and fever
• Hepatic encephalopathy: Liver damage impairs metabolic function, detoxification, especially ammonia detoxification. Toxins accumulate in the liver and travel through the bloodstream to the central nervous system, disrupting brain activity. Severe cases can lead to profound unconsciousness
• Gastrointestinal bleeding: Increased portal vein pressure stretches the veins around the stomach and rectum excessively, leading to rupture. Patients may vomit blood, pass bloody stools, and develop hemorrhoids. Sudden blood loss can cause rapid hypotension, dizziness, and fainting. Untreated cases can result in death
• Liver cancer: Liver fibrosis is a significant risk factor for developing liver cancer

Early detection and treatment help minimize the dangerous complications of liver fibrosis. Therefore, when experiencing unusual symptoms, it is crucial to seek medical attention for examination and diagnosis.

The symptoms of liver fibrosis depend on the disease stage and the patient's condition. In the compensated stage of liver fibrosis, symptoms are often subtle, and sometimes even absent, leading patients to potentially confuse it with other conditions. Initial signs of liver fibrosis include:

• Loss of appetite
• Fatigue
• Nausea
• Mild fever
• Unexplained weight loss

As the disease progresses to decompensated liver fibrosis, more severe symptoms emerge, including:

• Ascites, commonly known as abdominal distension (accumulation of fluid in the abdominal cavity)
• Peripheral edema (appearance of twisted veins under the skin in the abdominal area)
• Jaundiced skin, yellowed sclera
• Itchy and darkened skin
• Red palms (palmar erythema)
• Swollen lower limbs
• Dark-colored urine
• Paler than usual stools
• Bloody stools or vomiting blood
• Confusion, impaired memory, irritability
• Decreased libido

A telltale sign of transitioning from compensated to decompensated stage is the appearance of ascites.

To avoid severe disease progression, regular health check-ups are recommended for early detection and easier treatment, preventing dangerous complications.

Liver fibrosis, though challenging to cure completely, is highly preventable through simple measures. To prevent liver fibrosis, you should implement the following methods:

• Limit alcohol consumption: the leading risk factor for liver fibrosis is excessive alcohol abuse. Therefore, individuals need to control their alcohol intake to minimize the risk of developing liver fibrosis. Patients undergoing liver fibrosis treatment should abstain from alcohol entirely
• Maintain a healthy weight
• Engage in regular and consistent physical exercise
• Ensure sufficient sleep, maintain a healthy diet rich in green vegetables and fruits, and consume protein-rich foods
• Limit fat intake and reduce daily salt consumption
• Maintain a positive mood, avoid prolonged stress and anxiety
• Quit smoking
• Receive vaccinations for hepatitis A, B, and C prevention
• When using medications, adhere to the doctor's prescribed dosage and avoid self-adjustment

In addition to these measures, regular health check-ups are crucial for timely disease detection. Moreover, when observing unusual signs in the body, seeking medical attention for diagnosis and prompt treatment is essential.

The treatment methods for liver fibrosis depend on the extent of damage and the patient's condition. Based on the cause and symptoms of the disease, doctors will choose safe and highly effective treatment methods. Patients may be hospitalized for an extended period if liver function is severely compromised. The treatment of liver fibrosis is usually tailored to the cause of the disease and any complications that may arise.

For early-stage liver fibrosis, patients may be treated with the following approaches:

• Use of medications to control hepatitis B, C viruses: this method is widely applied and helps effectively control hepatitis B, C viruses. Medications such as antiviral drugs (Lamivudine, Interferon A...), immune modulators, and regulators may be prescribed
• Weight loss: cases of liver fibrosis due to non-alcoholic fatty liver disease require the control of blood sugar levels and weight
• Alcohol cessation: individuals with liver fibrosis should completely abstain from alcohol and alcoholic beverages to minimize cell damage

When liver fibrosis progresses to complications, the doctor will prescribe appropriate treatment methods based on the type and severity of the complications:

• Ascites and edema: the use of diuretics, a low-salt diet, and albumin infusion are effective methods to significantly reduce fluid retention. In addition, patients may undergo procedures to drain abdominal fluid
• Increased portal vein pressure: certain blood pressure medications can control elevated portal vein pressure and prevent gastrointestinal bleeding. Regular upper digestive endoscopy and colorectal examination help doctors detect distended esophageal veins and the anus to prepare for necessary interventions when needed
• Liver transplantation: this is the preferred method for patients with severe liver function impairment