Alerts and Notices
SynopsisLiver 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
Differential Diagnosis & PitfallsLiver 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:
- Nonalcoholic fatty liver disease
- Chronic viral hepatitis (A, B, C)
- Autoimmune hepatitis
- Progressive familial intrahepatic cholestasis
- Alcoholic liver disease
- Primary sclerosing cholangitis
- Primary biliary cirrhosis
- Chronic parenteral nutrition exposures
- Congenital hepatic fibrosis
- Autosomal-recessive polycystic kidney disease
- Choledochal 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