Fibrosis of the liver 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 do not occur in them. However, it is still a serious illness with consequences.
What causes it? How does it develop? How is it diagnosed? What is needed for its treatment? This and many other things will be discussed now.
Pathogenesis
Fibrosis of the liver is not an independent disease. As a rule, it is formed as a result of other pathologies that in one way or another affected the hepatic structures.
Fibrosis is a compensatory process. In its course, damaged liver tissue is replaced by scar tissue. This pathology occurs against the background of almost all liver diseases. And she is accompaniedprogressive slow destruction of this organ.
Over time, the so-called parenchymal thickening and further restructuring of tissues is formed. First, this leads to the suppression of liver functions, and then to their complete loss.
These complications are due to the fact that fibrous tissues do not have the ability to function. So in 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). Everything leads to the formation of an accumulation of fibrous tissues, which, as a result, replace normal cells. This is precisely the "start" from which the disease begins to develop.
Reasons
There are many factors that can lead to the development of symptoms of liver fibrosis. These include:
- Excessive drinking for 7-8 years.
- Hepatitis of viral origin (D, C, C). Against their background, acute lesions of the hepatic tissues of an inflammatory nature often develop.
- Hereditary factor. If a person's closest relatives have or had fibrosis, then he is also prone to the appearance of this pathology.
- Failures in the immune system. Diseases of the bile ducts, for example. Or autoimmune hepatitis, in which immune cells destroy their own liver cells.
- Viral pathologies. Mononucleosis, for example, or cytomegalovirus infection.
- Hepatitis toxicorigin. Accompanied by liver damage by poisons, chemicals and toxic substances.
- Hypertension, which has a portal form.
- Pathology of the biliary tract. They are dangerous in themselves, but they also have consequences.
- Taking drugs with a hepatotropic effect. These are the drugs prescribed to fight against tumor formations.
- Venous congestion.
- Pathologies caused genetically. For example, Wilson-Konovalov disease.
As you can see, there are many provoking factors. Therefore, in order to prescribe the correct treatment, it is necessary to conduct a detailed diagnosis to identify the etiology. Because by acting only on the symptoms, the result will not be achieved.
General clinical picture
It is worth briefly listing the symptoms of liver fibrosis. The disease develops slowly, and at first the patient has no complaints. But nevertheless it shows itself. The first sign is regular unreasonable fatigue. And then the following signs begin to appear:
- Violation in the work of organs.
- Deterioration of blood circulation.
- General malaise.
- The occurrence of bruising even after slight physical impact on the skin.
Within 6-8 years, the liver is destroyed. And then the disease makes itself felt. It manifests itself 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.
- Increasespleen.
- Esophageal varicose veins are often accompanied by bleeding from them.
- Anemia, leukopenia and thrombocytopenia.
- Increased portal and splenic pressure.
- The appearance or disappearance of ascites (accumulation of fluid in the abdominal cavity).
- Problems with digestion and heaviness in the hypochondrium.
- Skin rashes and itching.
- Shortness of breath. It intensifies over time. May be accompanied by a dry cough.
- Shallow rapid breathing, chest pains.
- Appearance of a bluish discoloration of the skin (cyanosis).
- Heart failure and frequent bronchitis.
- Local 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.
Disease types
There are several of them, and they all depend on the prevalence of the pathological process and its type. There are the following types of liver fibrosis:
- Focal (local). This is a limited process that provokes the appearance of only single foci. This variety is usually referred to as the first degree of liver fibrosis.
- Diffuse. It is diagnosed in the last stages of the development of the disease - when the pathological process extends to a large amount of tissue.
- Perihepatocellular. Usually occurs due to alcoholic lesions, syphilis and hypervitaminosis A.
- Zone. It is characterized by a cylindrical expansion of the portal fields.
- Multibular. With this type of pathology, false lobules include hepatic segments. For this reason, central veins and portal tracts are visible in them.
- Bridged. It is characterized by the formation of connective tissue septa (partitions) between the hepatic vessels.
- Reductal. With this form of the disease, connective tissue growths are observed along large ducts.
- Periportal. In this case, fibrotic tissue is deposited in the region of the center of the classical liver lobules. That is, where the central vein is.
Also noteworthy is cystic fibrosis. This is a separate disease. It is associated with metabolic disorders. In people who have been subjected 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 only for months, but for years.
Morphologically, the disease manifests itself in the destruction of the portal tracts. Normal tissue is replaced by connective cords, but septa do not form.
In the first degree, the following symptoms may also be observed:
- Emotional lability(mood instability).
- Irritable.
- Sleep problems.
- Distraction.
- Increased fatigue.
- Apathy.
- Significant performance degradation.
- Hematomas and bleeding appear as if from nowhere.
- Anemia.
- Increased susceptibility to infections.
- Decreased level of cellular immunity.
Even the first degree of the disease is a cause for concern. Its presence means that an irreversible process is taking place in the human body, accompanied by the destruction of the liver.
The problem is that the first stage is diagnosed very rarely, since the patient has no complaints, which means there is no reason to see a doctor. The presence of the disease can usually be determined by chance. As part of a routine examination, for example.
Second degree
Fibrosis of the liver passes to this stage 4 years after the beginning of its formation. During all this time, hepatocytes (parenchyma cells) die, which leads to deterioration in the functioning of the liver and in the performance of its main functions.
At the second stage of the disease, the following signs of liver fibrosis make themselves felt:
- Spleen enlargement.
- Bleeding of the esophagus.
- Liver enlargement.
- The appearance of thrombocytopenia. It is characterized by a decrease in the number of platelets in the blood. The level is less than 150109/l. Warning signs that point to this: increased bleeding and problems with stopping bleeding.
Up to the second degree, pathology can develop for longer than four years. But if a person regularly suffers from infectious diseases, then it will take less time. Each blow to the immune system only accelerates the formation of thrombosis in the hepatic 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 enters the third stage, the changes occurring in the organ become impossible to stop and reverse. Because most of the liver cells have already been 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 in the third degree, the following signs begin to show themselves:
- Loss of appetite.
- Nausea and even vomiting. They appear if a person eats improperly - consumes alcohol, marinades, smoked meats and fatty, spicy, fried foods.
- Dyspeptic phenomena. These include upset stools, heartburn, bloating, rumbling, belching, and flatulence.
- Non-passing pain in the right hypochondrium and a feeling of heaviness. The degree of intensity can be different, as well as the nature of sensations. Patients may complain of aching and nagging pains, as well as sharp and unbearable pains.
- 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 productsaccumulate in the blood.
- Swelling of the extremities, manifesting itself in the late afternoon.
- Bleeding gums and nose.
- Increase in body temperature to 37.5 °C. This indicator can last for a long time.
In addition to the above, darkening of urine is often observed. It becomes similar in color to dark beer. This is due to an excess of bilirubin, as well as its breakdown products.
The lipid metabolism in the tissues is also 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. Fluid is still accumulating 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 ability to neutralize toxic substances.
The latter are carried throughout the body through the bloodstream, having a negative effect on brain cells and the nervous system. That is why mental disorders usually occur at the last stage of fibrosis. Their presence is indicated by:
- Emotional instability.
- Depression.
- The appearance of unfounded fears.
- Prone to depression.
- Slowness.
- Increased anxiety.
- Memory problems.
- Disordered concentration.
- Loss of ability to absorb new information.
At this stage of liver fibrosis, the prognosis is very sad. Diseaseprogresses irrevocably, and as a result, such problems appear:
- Pain in the right hypochondrium accompanied by a feeling of heaviness and colic.
- Blood appears in the vomit.
- Itchy skin caused by accumulated bile.
- Dramatically losing weight. Even with a normal diet, severe exhaustion occurs.
- Significantly reduced muscle tone.
- Skin peels off and turns bright yellow.
- Xanthelasmas appear - formations similar to corns, but with a lipid component (fats).
- The upper phalanx is getting thicker. Around the nails, the skin turns blue.
- Joins ache and become inflamed.
- Men's breasts are greatly enlarged. Many face impotence.
- The veins in the abdomen expand.
- The body is covered with spider veins. The more 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 tongue grows in size.
Can liver fibrosis be cured at this stage? Theoretically yes. This stage is cirrhosis of the liver. The prognosis is unfavorable. A liver transplant is required. Otherwise, the progression of the disease cannot be stopped. At this stage of fibrosis, against the background of complications, life expectancy in 40% of patients does not exceed 3 years.
Diagnosis
Much has been said above about the symptoms and causes of liver fibrosis. Brieflyit is worth discussing the methods by which this disease is diagnosed.
So, there are laboratory methods:
- Complete blood count. The study of this biomaterial will reveal the presence of viral hepatitis, determine blood clotting, erythrocyte sedimentation rate, as well as find out the level of leukocytes and hemoglobin.
- Testing for fibrosis markers - PGA-index.
- Study of the biochemical composition of blood. It helps to check the functions of the liver and pancreas, as well as determine how much micronutrients are in the plasma.
- General analysis of urine and feces, coprogram for clay invasion.
- Study for antimitochondrial, antinuclear and antismooth muscle bodies.
Instrumental methods can also be applied to detect and analyze liver fibrosis. These include:
- Esophagogastroduodenoscopy (EGDS). It implies a detailed study of the mucous membrane of the stomach, esophagus and duodenum 12.
- Ultrasound. This procedure is aimed at identifying focal areas on the liver of the connective tissue, as well as identifying disorders in the kidneys, intestines and bile ducts.
- Computed tomography. Thanks to this procedure, it is possible to exclude tumor processes. The exact location of lesions can also be determined.
- Fine needle biopsy. Helps to establish an accurate diagnosis - cirrhosis, fibrosis or oncology.
- Elastometry. This is similar to a biopsy. A new method for studying the liver. The procedure is carried out by means of the Fibroscan apparatus, it takesonly 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 be cured.
Treatment
Regardless of how mild a person's degree of liver fibrosis is recorded on the Metavir scale, the doctor prescribes therapy. Even the initial stage can be aggravated and transferred to the second stage by the wrong, self-prescribed treatment.
First, you need to follow a diet for liver fibrosis. It is necessary to abandon everything that contains fats and alcohol. This will aggravate the condition of the body, and the diet, on the contrary, is aimed at restoring it.
You need to actively consume proteins. They promote 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, you need to eat plenty of vegetables and fruits (citrus fruits, in particular) and observe the drinking regimen. It is advisable to completely abandon s alt 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? Reception of drugs is prescribed only by a doctor. Tocopherol, Ursofalk, Interferon, Karsil, Kipferon, Essentiale, Ursosan, Viferon, as well as lipoic and ascorbic acid are usually prescribed.
You can also try using folk remedies. They cannot cure liver fibrosis, but their intake can be a concomitant therapy and good prevention. To restore the normal function of the organ, you can drink decoctions or infusions of rose hips, corn stigmas and milk thistle three times a day in small portions.
Well, it just so happens that there are no nerve endings in the liver tissue. Therefore, it cannot get sick, and many people often find out about fibrosis too late. Therefore, it is strongly recommended to have a general examination at least once a year in order to avoid problems and expensive long-term treatment.
