The liver performs numerous functions, including filtering toxins, producing proteins, and aiding digestion. When the liver sustains chronic damage, its natural healing process can lead to scar tissue formation. This scarring is a common response to ongoing inflammation and injury.
Understanding Liver Fibrosis
Liver fibrosis is the accumulation of excessive scar tissue in response to persistent injury. It occurs when specialized cells produce collagen and other proteins. While mild scarring is part of normal healing, prolonged injury causes these proteins to build up, forming fibrous septa that can gradually replace healthy liver tissue. This accumulation can impair the liver’s ability to function properly.
The Significance of Bridging Fibrosis
Bridging fibrosis is an advanced stage of liver scarring. It occurs when fibrous septa, or bands of scar tissue, extend from one area of the liver to another, forming connections. These connections typically link adjacent portal tracts or connect portal tracts to central veins. This extensive scarring disrupts the normal flow of blood and bile within the liver, impeding its functions.
Common Causes of Liver Fibrosis
Chronic viral infections, particularly chronic hepatitis B and hepatitis C, are frequent causes of liver fibrosis. Non-alcoholic fatty liver disease (NAFLD) can progress to non-alcoholic steatohepatitis (NASH), a more severe form involving inflammation and liver cell damage. Excessive alcohol consumption also leads to alcoholic liver disease, where alcohol metabolites directly injure liver cells, triggering a fibrotic response. Autoimmune liver diseases, such as autoimmune hepatitis or primary biliary cholangitis, involve the body’s immune system mistakenly attacking liver cells, causing chronic inflammation and scarring. Certain genetic conditions, like hemochromatosis (iron overload) or Wilson’s disease (copper overload), can also cause liver injury and fibrosis over time.
Identifying Bridging Fibrosis
Recognizing bridging fibrosis often involves a combination of diagnostic approaches, as symptoms are frequently subtle or absent in the earlier stages. As the scarring progresses, individuals might experience non-specific symptoms such as persistent fatigue, general weakness, or mild discomfort in the upper right abdomen.
Blood tests are often an initial step, with liver function tests indicating liver inflammation or damage, and specific fibrosis markers providing clues about the extent of scarring. Imaging studies, including ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI), can assess liver size, shape, and signs of chronic disease. More specialized imaging techniques, such as transient elastography, measure liver stiffness as an indicator of fibrosis. A liver biopsy, however, remains the most definitive method, involving the microscopic examination of a small liver tissue sample to directly visualize the presence and extent of bridging fibrous septa.
Approaches to Managing Bridging Fibrosis
Managing bridging fibrosis primarily focuses on addressing and eliminating the underlying cause of liver injury to halt or potentially reverse the scarring process. For chronic hepatitis B or C, specific antiviral medications are administered to suppress or clear the viral infection, thereby reducing inflammation and preventing further fibrosis progression. Individuals with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) are advised to implement significant lifestyle changes, including weight loss through dietary modifications and regular physical activity.
For alcoholic liver disease, complete abstinence from alcohol is paramount to prevent ongoing liver damage and allow for potential recovery. Treating autoimmune liver diseases involves immunosuppressive medications to control the immune response attacking the liver. Genetic conditions like hemochromatosis are managed through iron removal (phlebotomy), while Wilson’s disease requires medications to remove excess copper. Regular monitoring through blood tests and imaging is maintained to assess fibrosis progression or regression. Early and consistent intervention can lead to a reduction in the amount of scar tissue in some cases, improving liver function and preventing advancement to cirrhosis.