Liver fibrosis

Fibrosis itself does not cause symptoms. Symptoms may result from the disorder causing fibrosis. The main causes are chronic hepatitis B and C, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Also, if fibrosis progresses, cirrhosis may develop, and this can cause complications (such as portal hypertension) that give rise to symptoms. Early symptoms of cirrhosis include:

• tiredness and weakness
• loss of appetite
• nausea
• tenderness in the liver area

Later symptoms as the liver struggles to function include:

• swelling of the legs, ankles and feet (oedema) or abdomen (ascites)
• extreme fatigue
• very rapid heartbeat
• vomiting blood
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Your consultant will discuss your symptoms with you and may recommend tests to aid diagnosis. Diagnosis is made through a combination of an assessment of your medical history, a physical examination, and the following:

• Blood tests, commonly liver function tests (LFT), that can measure levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) which are elevated during inflammation.
• Transient elastography (FibroScan) to measure scarring levels.
• A liver biopsy may be required, where a tiny piece of your liver is taken to determine the cause of fibrosis.
• An endoscopy to check for varices (abnormally dilated vessels) in the oesophagus or stomach, which may rupture.

If a diagnosis of liver fibrosis is confirmed, your consultant will discuss your treatment options with you, to determine the best approach.

The aim is to treat the cause, which often stops or slows further scarring. Treatments include:

• weight loss and blood sugar control if you have non-alcoholic fatty liver disease (NAFLD)
• not drinking alcohol if you have alcoholic liver disease (ALD)
• antivirals in the case of chronic viral hepatitis
• corticosteroids or immunosuppressants in the case of autoimmune hepatitis
• A liver transplant is only recommended if other treatments are no longer helpful and if your life is threatened by end-stage liver disease.
  
  In some cases, if standard treatments have not been effective, transplant is not always an option for all patients. Transplant criteria must be met and decisions are made on a case-by-case basis.