How to Diagnose Liver Fibrosis

Co-authored by Muhammad Khan, MD, MPH and Janice Tieperman

Last Updated: September 3, 2021 References

Depending on your lifestyle or family history, liver fibrosis, or scarring, may be a very real and valid concern for you. Try not to worry—although it’s a serious condition, liver fibrosis on its own is not life-threatening.^{[1]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} With the proper precautions and medical advice, liver fibrosis is really easy to understand and identify. To help you get started, here are a few answers to some of your frequently-asked questions.

Question 1

Question 1 of 8:
What is liver fibrosis?

1
Liver fibrosis happens when a lot of scar tissue grows on your liver. The liver repairs itself whenever it gets damaged. When the liver gets damaged over and over again, scar tissue grows instead of regular, healthy tissue—this is known as fibrosis.^{[2]
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Expert Source

Muhammad Khan, MD, MPH
Board Certified Gastroenterologist
Expert Interview. 24 August 2021.}^{[3]
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Research source}
- Unfortunately, scarred liver tissue doesn’t work as well as healthy tissue.^{[4]
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  Research source}
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Question 2

Question 2 of 8:
What causes liver fibrosis?

1
Alcohol abuse can cause liver fibrosis. One of the liver’s main jobs is breaking down and clearing out any toxins in your blood. Whenever you enjoy an alcoholic drink, your liver filters out the alcohol from your bloodstream. If a person drinks too much, liver cells can get destroyed, which leads to scarring.^{[5]
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Expert Source

Muhammad Khan, MD, MPH
Board Certified Gastroenterologist
Expert Interview. 24 August 2021.}^{[6]
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Research source} Because of this, alcohol abuse is closely associated with liver fibrosis.^{[7]
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Research source}
2
Viral hepatitis C can lead to liver fibrosis.^{[8]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} Hepatitis C spreads through infected blood and causes a liver infection, which can lead to scarring. Don’t worry—while there isn’t a vaccine for this virus, you’re much less likely to catch it as long as you don’t share needles and other personal items with people.^{[9]
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Trustworthy Source
Centers for Disease Control and Prevention
Main public health institute for the US, run by the Dept. of Health and Human Services
Go to source}
- For instance, drug needles, tattoo or piercing needles, razors, and glucose monitors can all potentially spread hepatitis C.^{[10]
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  Trustworthy Source
  Centers for Disease Control and Prevention
  Main public health institute for the US, run by the Dept. of Health and Human Services
  Go to source}
- Hepatitis B can also lead to liver fibrosis.^{[11]
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3
Nonalcoholic fatty liver may cause liver fibrosis. This condition is more common with people who are overweight, diabetic, or prediabetic, as well as people with high cholesterol.^{[12]
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Research source} Sometimes, people with nonalcoholic fatty liver develop liver inflammation, which can turn into scarring.^{[13]
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Research source} It’s okay—with a doctor’s guidance, this condition is very manageable and treatable.^{[14]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}

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Question 3

Question 3 of 8:
What are the symptoms of liver fibrosis?

1
Fibrosis on its own doesn’t have any symptoms. Instead, you might notice symptoms from the actual cause of your fibrosis, like excess alcohol or hepatitis C.^{[15]
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- For instance, itchy skin, fatigue, jaundice, and dark urine are all common symptoms of hepatitis C.^{[16]
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  Trustworthy Source
  Mayo Clinic
  Educational website from one of the world's leading hospitals
  Go to source}

Question 4

Question 4 of 8:
Who is most at risk for liver fibrosis?

1
People who take certain supplements and medications might be at risk.^{[17]
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Johns Hopkins Medicine
Official resource database of the world-leading Johns Hopkins Hospital
Go to source} Pills like acetaminophen (Tylenol), aloe vera, antidepressants, anticonvulsants, and many more can lead to liver damage. To be safe, always check with a doctor before taking any new medications or supplements.^{[18]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source}
- For a full list of supplements and medications that can hurt the liver, check the LiverTox database: https://www.ncbi.nlm.nih.gov/books/NBK547852.
2
Drinking too much alcohol puts you at risk. Regular drinking can lead to a condition known as alcoholic fatty liver, which inflames your liver.^{[19]
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Expert Source

Muhammad Khan, MD, MPH
Board Certified Gastroenterologist
Expert Interview. 24 August 2021.} Unfortunately, this can lead to scarring, like fibrosis and cirrhosis.^{[20]
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Trustworthy Source
Johns Hopkins Medicine
Official resource database of the world-leading Johns Hopkins Hospital
Go to source}
- If you stop drinking before any major scarring occurs, the alcoholic fatty liver can reverse on its own.
3
Certain health conditions or family history may play a part. Check-in with your close relatives and see if anyone has a history of liver disease. If a close family member has ever had hemochromatosis, alpha-1-antitrypsin deficiency, or Wilson disease, you might be more at risk for liver issues.^{[21]
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Trustworthy Source
Johns Hopkins Medicine
Official resource database of the world-leading Johns Hopkins Hospital
Go to source}
- At your annual doctor’s appointment, ask your physician to do a liver enzyme test. This is a great way to help you keep tabs on your liver health.
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Question 5

Question 5 of 8:
How can a doctor identify liver fibrosis?

1
A radiologist can perform an ultrasound or MRI elastography. In ultrasound elastography, radiologists study your liver with a probe and special sound waves, which help them determine where any scarring is. An MRI elastography locates scarring with an MRI machine and produces especially accurate results.^{[22]
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A doctor may take a biopsy. In a biopsy, a doctor collects samples of your liver with a thin needle. During the procedure, your doctor may collect up to 15 samples from different parts of the liver, so they perform more thorough testing. Unfortunately, this procedure can be pretty painful, and can only identify fibrosis in the small samples collected—not the entire liver.^{[23]
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- A biopsy is a lot more invasive and painful than an elastography.
3
Other imaging tests can help identify liver fibrosis. Abdominal ultrasounds and computed tomography (CT) scans are other non-invasive ways to identify scarred liver tissue. On an abdominal ultrasound and CT scan, scarred livers look a bit lumpier and smaller than a healthy liver.^{[24]
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Question 6

Question 6 of 8:
Does liver fibrosis develop at a consistent rate?

1
No, liver fibrosis can develop at different rates. Unfortunately, liver fibrosis doesn’t follow an exact timeline. Some people develop fibrosis slowly over several years, only to have scarring speed up later on. Other people can develop liver fibrosis very quickly—it really depends on the individual.^{[25]
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Question 7

Question 7 of 8:
What are the stages of liver fibrosis?

1
Fibrosis is the second stage of liver damage. Liver damage is charted in 4 stages: inflammation (stage 1), fibrosis (stage 2), cirrhosis (stage 3), and liver failure (stage 4). During stage 2, your liver develops extra scar tissue but still works fairly normally. In cirrhosis, your liver is scarred all over and may not work properly.^{[26]
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Question 8

Question 8 of 8:
Is liver fibrosis reversible?

1
Research suggests that mild or moderate liver fibrosis is reversible. Some studies show that, with proper treatment for hepatitis C, patients can heal and recover completely from the fibrosis.^{[27]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} If you have liver fibrosis, talk with a doctor to figure out a specific treatment plan.

Expert Q&A

Question

How does liver fibrosis occur?

Muhammad Khan, MD, MPH
Board Certified Gastroenterologist
Dr. Muhammad Khan is a Gastroenterologist, with over 10 years of experience. Dr. Khan specializes in Pediatric Gastroenterology, Hepatology, and Nutrition, and has a special focus in Therapeutic Endoscopy. He received his Bachelor’s, Master’s, and Doctorate of Medicine degrees from The University of Utah. Dr. Khan completed his residency training at Eastern Virginia Medical School, where he was inducted into the prestigious Alpha Omega Alpha honor society. He then completed his fellowship training at Lucile Packard Children’s Hospital at Stanford University. He is a Fellow of both the American Society of Gastrointestinal Endoscopy (ASGE) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN).

Muhammad Khan, MD, MPH

Board Certified Gastroenterologist

Expert Answer

Ultimately, liver damage causes liver fibrosis—this damage can be severe and all at once, or over frequent, small amounts of time.
Question

What is the best way to avoid developing cirrhosis?

Muhammad Khan, MD, MPH
Board Certified Gastroenterologist
Dr. Muhammad Khan is a Gastroenterologist, with over 10 years of experience. Dr. Khan specializes in Pediatric Gastroenterology, Hepatology, and Nutrition, and has a special focus in Therapeutic Endoscopy. He received his Bachelor’s, Master’s, and Doctorate of Medicine degrees from The University of Utah. Dr. Khan completed his residency training at Eastern Virginia Medical School, where he was inducted into the prestigious Alpha Omega Alpha honor society. He then completed his fellowship training at Lucile Packard Children’s Hospital at Stanford University. He is a Fellow of both the American Society of Gastrointestinal Endoscopy (ASGE) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN).

Muhammad Khan, MD, MPH

Board Certified Gastroenterologist

Expert Answer

Focus on changing your diet and increasing your exercise regimen. In more extreme cases, geriatric surgery might be an option as well.