| There are 2
main types, congenital and acquired liver fibrosis. The
former is a genetic disorder, which causes polycystic
liver diseases. The latter has many different categories
and is mainly caused by liver cell injuries. In this
article, we focus on acquired liver fibrosis.
Causatively, liver
fibrosis can be classified as:
1. Viral hepatitis
fibrosis: Usually caused by chronic hepatitis B, C, and
D. Worldwide, there are three hundred fifty million of
hepatitis B virus carriers, and one hundred seventy
million of hepatitis C infected people. About 15% of HBV
and 85% of HCV infected persons will develop chronic
hepatitis and lead to fibrosis. In which, the liver
shows peri-portal area inflammation and piecemeal
necrosis and fibrosis. With such large population being
affected, this is the most important category of the
liver fibrosis.
2. Parasitic infection
fibrosis: This kind of liver fibrosis is mainly
happening in developing countries and is caused by
schistosomiasis. There are two hundred and twenty
million people in Asia, Africa, South and Center America
suffering from this infection. The recurrent infection
and the eggs of schistosome accumulated in the liver can
cause liver fibrosis and cirrhosis.
3. Alcoholic fibrosis: It
is mainly caused by the oxidized metabolite of alcohol,
acetaldehyde. In western countries, the incidence of
this disorder is positively related to the amount of
alcohol consumption. The total cases of alcoholic
fibrosis in the USA is about three times higher than the
number of hepatitis C. Alcoholic fibrosis causes two
morphological changes in the liver: fatty liver and
cellular organelles deterioration. The fibrosis first
appears around the center veins and at the same time,
the liver parenchymal inflammation. Gradually the
fibrosis expends to the whole liver.
4. Biliary fibrosis:
There is primary and secondary biliary fibrosis. Primary
biliary hepatic fibrosis (PBHF) is an autoimmune
disorder in which chronic intra-liver bile retention
caused the liver fibrosis. It is more often affect
female around the age 40 to 60. In serum tests, elevated
gamma globulin and positive for the anti-mitochondria
antibody. Pathological studies found that the fibrosis
mainly around the micro-bile ducts and peri-portal area
fibrosis and inflammation. Secondary biliary fibrosis
happens following the obstruction of the bile ducts,
which causes peri-portal inflammation and progressive
fibrosis.
5. Metabolic fibrosis:
This category is not common and has fewer cases.
Wilson's disease or liver lenticular degeneration and
hemochromatosis are the main disorders that cause
metabolic fibrosis. The former is a genetic disorder and
causes cooper metabolism disorder and deposits in the
liver. The latter is an iron metabolic disorder and
causes hemoglobin deposits in the liver. Both of these
metabolic disorders can cause liver fibrosis and
cirrhosis.
6. Intoxication fibrosis:
When long-term contact with liver-toxic substances, such
as carbon-tetrachloride, organophosphorus, dimrthyl
nitrosamine, thioacetamide, or taking liver toxic
medications, such as isoniazid, thio-oxidizing
pyrimidine, wintermin, tetracycline, acetaminophen etc.
can all cause various degrees of liver cell injuries,
necrosis, bile retention, or allergic inflammation and
cause liver fibrosis.
7. Mal-nutritional
fibrosis: This type is mainly caused by insufficient or
imbalanced nutritional intake. A long-term low protein
or high fat diet can cause fatty liver and lead to
fibrosis.
8. Cardiogenic fibrosis:
Chronic congestive heart failure can cause long lasting
liver vein stagnancy. Which causes ischemic degeneration
of the liver cells. In this type of liver fibrosis, the
connective tissue hypertrophy starts at the center of
the liver lobule and gradually expands to rest of the
lobule.
Pathologically,
fibrosis can be classified as:
1. Portal area fibrosis:
There is fibroblasts proliferation and fibers expansion
from the portal areas to the lobule. Finally, these
fibers connected to form bridging septa. This kind of
fibrosis is mainly seen in viral hepatitis and
mal-nutritional liver fibrosis.
2. Intra-lobular
fibrosis: In which, there is almost no fibroblast found
in normal lobule. When large numbers of liver cells
degenerate and undergo necrosis, the reticular fiber
frame collapses and becomes thick collagen fibers. At
the same time, intra lobule fibrotic tissue proliferates
and surrounds the liver cells.
3. Central fibrosis:
Proliferated fibrotic tissue mainly surrounds the center
vein and causes the thickening of the wall of the center
vein.
4. Peri-micro-bile-duct
fibrosis: Type fibrosis mainly caused by long-term bile
retention and mainly happens around the bile ducts.
Microscopically, there are connective tissues
surrounding the newly formed bile canaliulus and
bile-plugs. The base-membrane of the bile canaliulus
become fibrotic.
Immunologically, it
can be classified as:
1. Passive fibrosis:
There are extensive necrosis of the liver cells and
secondary liver structure collapse and scar formation,
which causes connective tissue proliferation.
2. Active fibrosis: Lymph
cells and other inflammatory cells infiltration and
recurrent and consistent inflammation promote the
connective tissue to invade the lobule |