Advanced liver fibrosis Home A-Z Health Information Health Library A-Z Advanced Liver Fibrosis Overview Advanced liver fibrosis is the later stage of liver fibrosis, where significant scarring and damage to the liver tissue have occurred. This type of liver fibrosis can progress to cirrhosis, ultimately culminating in severe life-threatening conditions like portal hypertension, hepatocellular carcinoma (a type of liver cancer), or liver failure. Causes and risk factors The causes of advanced liver fibrosis are typically the same as those for early fibrosis, but the only difference is that they have persisted over a long period, leading to more severe liver damage. The causes and risk factors that differ to some extent from those of early liver fibrosis have been enumerated below (for others, please check early liver fibrosis).Chronic hepatitis C: Hepatitis C is associated with a higher risk of progressing to advanced fibrosis as compared to hepatitis B.Viral infections (other than hepatitis): HIV and other viral infections can exacerbate liver damage, particularly in individuals with hepatitis C.Chronic inflammation: Persistent liver inflammation due to autoimmune diseases, cholestasis (condition when the flow of bile from the liver is reduced or blocked), or chronic infections contribute to advanced fibrosis. Symptoms The symptoms of advanced liver fibrosis overlap to a large extent with those of early liver fibrosis and, therefore, can be checked by referencing the “early liver fibrosis” section. Other symptoms have been detailed below.Spider angiomas: In advanced stages of liver fibrosis, small, spider-like blood vessels appear on the skin (often on the chest, face, or hands).Palmar erythema: Redness in the palms of the hands—caused by blood flow changes in the liver—is also observed in some cases.Bruising and bleeding: Liver dysfunction can impair the production of clotting factors, leading to easy bruising and bleeding, such as nosebleeds or gum bleeding.Swelling in the legs or abdomen (oedema and ascites): Fluid retention can occur with declining liver function. Confusion or mental changes (hepatic encephalopathy): In severe cases, toxins that the liver can no longer filter out can affect the brain, leading to confusion, forgetfulness, or changes in behaviour. Diagnosis Most of the diagnostic techniques for advanced liver fibrosis overlap with those of early liver fibrosis, and the ones that differ (even slightly) have been enumerated below.Blood tests:Liver function tests: In advanced fibrosis, ALT, AST, ALP, and bilirubin levels may be persistently elevated, and albumin levels can be low.Prothrombin time (PT) test: PT is an indicator of the liver's ability to produce clotting factors. Though PT may be normal in early fibrosis, it is prolonged in advanced liver fibrosis.Analysis of fibrosis markers: The AST-to-platelet ratio index (APRI) is considered to be the best index for predicting significant liver fibrosis, and the combination of APRI and Fibrosis-4 (FIB-4) is the best for predicting patients with advanced fibrosis or cirrhosis. Treatment Most of the treatment strategies for advanced liver fibrosis overlap with those of early liver fibrosis, and the ones that differ (even slightly) have been enumerated below.Treating complications:Salt restriction, diuretics, and paracentesis (removal of fluid): These may be used to manage fluid retention or ascites.Lactulose: This can be used to reduce ammonia accumulation in the blood, thereby countering hepatic encephalopathy.Beta-blockers: These medications can be used to manage portal hypertension.Transjugular intrahepatic portosystemic shunt (TIPS): This procedure is used to reduce pressure in the liver’s blood vessels (portal hypertension).Liver cancer surveillance: Individuals with advanced liver fibrosis—especially cirrhosis—are at an increased risk of developing hepatocellular carcinoma (type of liver cancer). Regular screening via imaging and blood tests (e.g., AFP) is recommended. Prevention Vaccination: Individuals at risk should get vaccinated for hepatitis B and hepatitis A.