GI Conditions
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      2. GI Conditions

      Hepatic Fibrosis

      Brief Overview: Hepatic fibrosis is the accumulation of scar tissue in the liver due to chronic liver injury or inflammation. Over time, fibrosis can impair liver function and potentially progress to cirrhosis. It is caused by a variety of liver conditions, including fatty liver disease, viral hepatitis, alcohol-related liver disease, and autoimmune disorders.

      Etiology: Fibrosis develops when the liver attempts to repair ongoing damage caused by inflammation or injury. This results in excess production of collagen and extracellular matrix proteins that replace normal liver tissue. If the cause of liver injury continues, fibrosis may progress to cirrhosis.

      Risk Factors:

      • Alcohol abuse
      • MASLD
      • Chronic Hepatitis
      • Autoimmune Hepatitis
      • Genetics
      • Center medications

      Commonly Associated Conditions:

      • Type 2 Diabetes
      • Hepatitis B, C
      • Cirrhosis
      • Obesity
      • Dyslipidemia
      • Chronic Kidney Disease (CKD)

      Common Medications:

      • There are no direct anti-fibrotic medications approved yet
      • Medication to treat any underlying or associated condition

      Common Labs, Imaging, and Tests:

      • Serologic tests: AST to platelet ratio (APRI), FibroTest/FibroSure, Hepascore, FibroSpect; CBC, CMP, hepatic panel
      • Imaging: elastography, ultrasound, CT, MRI
        • FibroScan
      • FIB-4 index
      • LiverRisk score
      • NAFLD fibrosis score
      • Liver biopsy

       

      Common Symptoms:

      • Typically, asymptomatic
      • Fatigue
      • Right upper abdominal discomfort

      Common Treatments:

      • Medication to treat any underlying or associated condition
      • Weight loss, if indicated
      • Avoid alcohol
      • Dietary modifications
      • Liver transplant may be indicated in advanced disease

      Physical Findings:

      • Typically, normal physical exam
      • Hepatomegaly may be present

      Potential Complications and Contraindications:

      • Compensated chronic advanced liver disease (cCALD)
      • Cirrhosis
      • Ascites
      • Hepatic encephalopathy
      • Hepatorenal syndrome
      • Portal hypertension
      • Variceal bleeding
      • Hepatocellular carcinoma
      • Avoid certain medications and imaging studies if impaired liver/kidney function

      General Health and Lifestyle Guidance:

      • Avoid alcohol
      • Talk to your healthcare provider before taking any OTC supplements or vitamins
      • Ask your healthcare provider if you should avoid any OTC medications or home remedies
      • Exercise as directed by your healthcare provider
      • Follow any dietary guidelines given by your healthcare provider/dietician
      • Work with your healthcare provider to achieve and maintain control of any associated/underlying conditions
      • Stay up to date on all age-appropriate vaccinations (flu vaccine, pneumonia vaccine, shingles vaccine, Hep A vaccine, Hep B vaccine, Tdap). Ask your healthcare provider what vaccines are recommended for you.

       

      Suggested Questions to Ask Patients:

      • Have you ever been told you have fatty liver, hepatitis, or abnormal liver tests?
      • Are you currently managing diabetes, cholesterol, or weight?
      • Do you use alcohol or any supplements regularly?
      • Have you had a liver scan or biopsy in the past?
      • Are you aware of any other chronic conditions that could affect your liver?

      Suggested Talking Points:

      • Make sure to follow up with your healthcare provider as directed. Complete all imaging and blood work that your healthcare provider orders.
      • Consider working with a dietician if this is available to you.

      Sources:

      • UpToDate
      • Merck Manual
      • gov
      • Hoag Digestive Health Institute