Fibrosis and cirrhosis both happen because of liver damage due to factors such as excessive alcohol use, viral hepatitis, and obesity. Fibrosis is scarring of the liver. Scarring that is severe and permanent is called cirrhosis.
Liver disease affects an estimated
Fibrosis and cirrhosis result from liver disease. Fibrosis is scarring and stiffening of liver tissue. When this scarring becomes very severe and leads to permanent damage, it’s called cirrhosis.
While fibrosis and cirrhosis are very similar, they have some important distinctions. Keep reading to learn more about the similarities and differences between fibrosis and cirrhosis.
Fibrosis and cirrhosis can present differently.
Liver fibrosis symptoms
Most people with mild to moderate fibrosis have no symptoms. This means it’s possible to have some degree of liver damage and not be aware of it.
When fibrosis becomes very severe, healthcare professionals refer to it as cirrhosis. This is typically when you’ll start to experience symptoms.
Cirrhosis symptoms
As with fibrosis, some people with early cirrhosis may not have obvious symptoms. When symptoms of cirrhosis are present, they can include:
Fibrosis and cirrhosis have the same general causes, which are conditions that can cause injury to your liver. These include:
- viral hepatitis, particularly hepatitis B and hepatitis C
- alcohol-related liver disease
- non-alcohol-related fatty liver disease (NAFLD)
- autoimmune hepatitis
- bile duct diseases
- genetic conditions such as Wilson disease and primary hemochromatosis
Causes of liver fibrosis
Liver fibrosis happens as a result of persistent inflammation that affects your liver. Liver inflammation is called hepatitis.
Inflammation stresses your liver and can cause injury or death of healthy liver cells. In response, cells in your liver make more collagen and other proteins to help repair the damage. But if inflammation continues over time, collagen and other proteins can continue to build up in your liver.
Eventually, this leads to stiffening and scarring that begins to replace healthy liver tissue.
Causes of cirrhosis
Cirrhosis is caused by prolonged, severe liver scarring that is permanent and significantly affects your liver’s ability to function. Cirrhosis is typically categorized as the last, most severe stage of fibrosis.
Because the basic causes of fibrosis and cirrhosis are the same, their risk factors are as well. These risk factors include:
- chronic hepatitis B or hepatitis C infection
- excessive alcohol consumption
- unhealthy diet
- other underlying health conditions, such as:
- certain genetic conditions
Fibrosis and cirrhosis can affect your liver’s ability to function properly. This can lead to a variety of complications that can significantly affect your health.
The main complication of fibrosis is continued scarring that progresses to cirrhosis.
Cirrhosis can lead to complications such as:
- an increased risk of infections
- portal hypertension (high blood pressure in the portal vein of your liver)
- ascites (fluid buildup in your abdomen)
- varices (enlarged veins in your digestive system that can cause internal bleeding)
- hepatic encephalopathy (buildup of toxins in your brain that can lead to confusion and difficulty thinking)
- liver cancer
- liver failure
Fibrosis and early cirrhosis often don’t cause many symptoms. However, it’s important to see a doctor if you notice:
- lingering fatigue
- loss of appetite or unintended weight loss
- persistent upper right abdominal pain
- frequent nausea or vomiting
- itchy skin
- very dark urine
- pale stool
- jaundice
These can all be symptoms of a liver issue. A doctor can help determine what’s causing your symptoms and recommend an appropriate treatment.
Generally, fibrosis requires a liver biopsy or a noninvasive imaging test called elastography or Fibroscan, which tests how stiff your liver tissue is.
A doctor will diagnose cirrhosis by looking at the bigger picture of your overall health. They will take your medical history, perform a physical exam, and order tests, which may include:
- blood tests such as:
- FibroSure, which measures six blood markers linked with fibrosis and cirrhosis
- tests for hepatitis B or hepatitis C
- tests for autoimmune diseases
- imaging, such as:
If the test results and the causes of your symptoms (such as heavy alcohol use or a hepatitis C infection) are clear, then a biopsy may not be necessary.
Liver fibrosis is scored based on how much scarring is in your liver. There are a few scoring systems, but one example is the Metavir scoring system, which scores fibrosis from 0 to 4.
A higher score means fibrosis is more severe. The scores generally break down as follows:
- F0: no fibrosis
- F1: mild fibrosis
- F2: moderate fibrosis
- F3: severe fibrosis
- F4: cirrhosis
Healthcare professionals may approach the treatment of liver fibrosis and cirrhosis differently.
Liver fibrosis treatment
The Food and Drug Administration (FDA) has not approved any medications for fibrosis, according to a
Instead, treatment focuses on addressing the cause of the fibrosis with the goal of slowing or stopping its progression. This can involve:
- treating chronic hepatitis B or hepatitis C
- avoiding alcohol consumption
- eating a nutritious and balanced diet
- staying physically active
- making an effort to lose weight if you have obesity
- addressing autoimmune conditions through the use of immunosuppressants, biologics, or corticosteroids
- using medications or procedures to help open bile ducts
- using phlebotomy or iron chelation to manage hemochromatosis or copper chelation to treat Wilson disease
Cirrhosis treatment
As with fibrosis, the treatment of cirrhosis involves treating underlying causes.
Additional treatment can help address cirrhosis complications. These treatments can include:
- using blood pressure medications for portal hypertension and varices
- taking antibiotics for bacterial infections
- taking medications to reduce swelling due to fluid buildup in your abdomen or lower body
- draining fluids that have built up in your abdomen
- using lactulose syrup for hepatic encephalopathy
- undergoing procedures to address bleeding from varices
- receiving cancer treatments, such as surgery, chemotherapy, or radiation therapy, for liver cancer
A doctor may recommend a liver transplant if you meet certain conditions. Your eligibility will depend on many factors, such as your age, other medical conditions you have, and your ability to stick to a post-transplant treatment plan.
The outlook for fibrosis and cirrhosis can also differ.
Liver fibrosis life expectancy and outlook
Liver fibrosis is reversible if its underlying cause is treated. However, according to a
Generally, the outlook becomes less favorable as the severity of fibrosis increases. This is illustrated by a
| Fibrosis stage | Additional life expectancy | 10-year mortality due to liver disease | 10-year non-liver-related mortality |
|---|---|---|---|
| F0 (no fibrosis) | 25.3 years | 0.1% | 1.8% |
| F1 (mild) | 25.1 years | 0.2% | 2.4% |
| F2 (moderate) | 23.6 years | 1.0% | 5.2% |
| F3 (severe) | 21.1 years | 4.0% | 9.7% |
| F4 (cirrhosis) | 13.8 years | 29.3% | 15.6% |
Cirrhosis life expectancy and outlook
Unlike the damage from fibrosis, damage that has occurred in cirrhosis is permanent and is not reversible. The outlook can depend on the type of cirrhosis.
If you have compensated cirrhosis, you may not seem to be ill. You might have no symptoms, or you might have mild symptoms such as fatigue, nausea, and upper right abdominal pain.
In decompensated cirrhosis, your liver has great difficulty functioning. You may have more severe symptoms, such as jaundice, and may experience cirrhosis complications.
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You can take several steps to help prevent fibrosis or cirrhosis, such as:
- limiting your alcohol consumption or abstaining from alcohol completely
- focusing on eating a nutritious, balanced diet
- engaging in regular physical activity
- making an effort to lose weight if you have obesity
- taking all medications exactly as directed
- getting vaccinated against hepatitis B
- reducing your risk of viral hepatitis by avoiding contact with the blood or body fluids of others, such as by:
- not sharing personal care items like razors or toothbrushes
- not sharing injection needles or syringes
- using a condom or other barrier method during sex
- avoiding unregulated tattooing or piercing establishments
Now let’s answer some additional questions about fibrosis and cirrhosis.
What comes first, cirrhosis or fibrosis?
Liver fibrosis happens first. When liver fibrosis becomes severe and permanent and starts to affect liver function, it’s called cirrhosis.
How long does it take to progress from fibrosis to cirrhosis?
Progression of fibrosis to cirrhosis is typically slow. It can often take
Can you have fibrosis without cirrhosis?
Yes. There are different stages of fibrosis. The specific stages can depend on the scoring system used, but generally the severity of fibrosis increases as the stage increases. Cirrhosis is typically the last (highest) stage of fibrosis.
How serious is fibrosis of the liver?
Fibrosis of the liver can become serious if it progresses to cirrhosis. At that point, irreversible liver damage has occurred and can cause a variety of health problems.
Is liver fibrosis reversible?
Yes. If you identify and treat it early, it’s possible to reverse liver fibrosis.
Fibrosis and cirrhosis both happen when your liver is damaged over time. Underlying causes include excessive alcohol consumption, viral hepatitis, and autoimmune conditions.
Fibrosis is liver scarring. Cirrhosis is liver scarring that is severe and permanent and significantly affects liver function.
Liver disease can lead to serious and life threatening complications. Consult a doctor if you have symptoms such as persistent upper right abdominal pain, frequent nausea and vomiting, or jaundice.