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Liver fibrosis
Other Resources UpToDate PubMed

Liver fibrosis

Contributors: Michael W. Winter MD, Nishant H. Patel MD, Desiree Rivera-Nieves MD, Khaled Bittar MD
Other Resources UpToDate PubMed


Liver fibrosis is a histologic finding describing scarring that occurs in response to chronic liver injury. Fibrosis is characterized by the loss of typical liver architecture to replacement with nodules and fibrous septations. There are numerous causes of liver fibrosis; chronic alcohol exposure, viral hepatitis (B and C), and nonalcoholic fatty liver disease are among the more common etiologies in the United States.

Liver fibrosis can progress to cirrhosis. Cirrhosis can present with ascites, gastrointestinal bleeding (portal gastropathy or varices), jaundice, fatigue, or infections due to an impaired immune system.

Fibrosis refers to histologic findings and is therefore diagnosed on liver biopsy. However, surrogate markers exist (eg, FibroSure / FibroTest, an indirect serum marker panel [6 blood serum tests]) that generate a score correlated with the degree of liver fibrosis in the absence of a liver biopsy.

Fibrosis is typically progressive over months to years. It is important to identify the underlying etiology of chronic liver injury to reverse or slow the progression of fibrosis toward cirrhosis and end-stage liver disease.


K74.00 – Hepatic fibrosis, unspecified

62484002 – Hepatic fibrosis

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Differential Diagnosis & Pitfalls

Liver fibrosis is a histologic diagnosis. A liver biopsy demonstrating fibrosis is highly sensitive and specific.

Possible etiologies of chronic liver disease that can lead to fibrosis include the following:
  • Metabolic dysfunction-associated steatotic liver disease
  • Chronic viral hepatitis (Hepatitis A virus infection, Hepatitis B virus infection, Hepatitis C virus infection)
  • Autoimmune hepatitis
  • Progressive familial intrahepatic cholestasis
  • Alcoholic hepatitis
  • Primary sclerosing cholangitis
  • Primary biliary cholangitis
  • Chronic parenteral nutrition exposures
  • Congenital Liver fibrosis
  • Autosomal-recessive Polycystic kidney disease
  • Biliary cyst
  • Caroli disease
  • Drug-induced hepatotoxicity
  • Metabolic liver disease (eg, Wilson disease, Alpha-1 antitrypsin deficiency)
  • Jeune syndrome
  • Joubert syndrome
  • Oculo-encephalo-hepato-renal syndrome
  • Cystic fibrosis
  • Congestive heart failure
  • Autosomal recessive renal-hepatic-pancreatic dysplasia
  • Budd-Chiari syndrome

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Last Reviewed:05/23/2017
Last Updated:07/09/2020
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Liver fibrosis
A medical illustration showing key findings of Liver fibrosis : Hepatomegaly, Jaundice, Nausea, ALT elevated, Ascites, Liver failure, Malaise, PT prolonged, RUQ pain
Copyright © 2024 VisualDx®. All rights reserved.