Inflammation occurs when a healthy liver works hard to remove poisons or intruders while also healing damaged cells. Both damaged liver cells and immune cells send out signals to activate particular repair cells that migrate to the location of the injury. Collagen, a fiber released by these repair cells, stiffens the tissue around the cells, protects the surviving cells, and promotes recovery. This healing process is very tightly regulated in a healthy liver, and when the extra collagen is no longer needed, it disperses, and the liver returns to normal.
When a person suffers from liver disease, their liver enters a hazardous cycle. Hepatitis, or chronic inflammation, delivers constant signals to the repair cells to keep depositing collagen. The additional collagen stiffens around the tissue, just as it should in a healthy liver; but, instead of a signal being sent to cease the inflammation and discard the extra collagen, the inflammation persists, and more collagen is deposited, causing more stiffening. This is how fibrosis manifests itself.
Collagen and other proteins build up between liver cells due to repeated damage or long-term inflammation, generating scar tissue. Scar tissue within the liver can obstruct or restrict blood flow, starving and killing healthy liver cells and causing additional scar tissue to grow. Scar tissue, unlike healthy liver cells, is unable to function or mend itself. Fibrosis can impair the liver’s capacity to perform, limit its ability to repair itself, and restrict blood flow as it progresses. Scars in the liver will continue to form and replace healthy tissue over time. The lesions gradually slither outward, covering more of the good liver, and grow together, or bridge, forming septa or scar tissues. Fibrosis also reduces blood flow; when a doctor wants to know how bad the scarring is, they look at how it affects the portal blood flow (the portal vein brings all the blood from the intestines to the liver to be processed).
Fibrosis in low to moderate level is generally asymptomatic. Many people live with liver damage, or fibrosis, without being detected until they develop cirrhosis symptoms, due to a lack of signs. If diagnosed early enough, fibrosis can be reversed, and the underlying liver illness that caused the fibrosis can be cured or treated. If untreated, fibrosis can progress to cirrhosis and liver cancer. It’s vital to keep in mind that the progression of fibrosis to cirrhosis takes a long time. The time it takes for fibrosis to progress varies depending on the condition and the individual. Cirrhosis does not affect everyone who develops fibrosis. Cirrhosis does not always lead to malignancy.
It’s critical to understand the level of your liver damage if you’ve been diagnosed with liver disease. The stage of your liver disease will influence the health decisions you and your care team make. People with extensive fibrosis or cirrhosis will need to be monitored for liver cancer, may need to avoid certain medications, and may need to see their doctor for blood tests more frequently. Several tests can be used to determine whether or not you have liver damage. There are a few different scoring systems in used as well.