Cirrhosis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Sudarshana Datta, MD [3]

Overview

There are a wide range of causes for cirrhosis, including alcohol abuse, genetic diseases, cardiac causes, toxins, viruses, and malnutrition. The consequence is the same in all cases with the functional liver tissue being replaced by fibrous scar tissue and regenerative nodules.

Causes

Common causes

Cirrhosis has many possible causes; sometimes more than one cause is present in the same patient. In the Western World, chronic alcoholism and hepatitis C are the most common causes. Hepatitis B is more common in parts of sub-Saharan Africa and Asia.

• Alcoholic liver disease
• Chronic hepatitis C
• Chronic hepatitis B
• Non-alcoholic steatohepatitis (NASH)
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Autoimmune hepatitis
• Hereditary hemochromatosis
• Wilson's disease
• Alpha 1-antitrypsin deficiency
• Cardiac cirrhosis
• Galactosemia
• Glycogen storage disease type IV
• Cystic fibrosis
• Drugs or toxins
• Certain parasitic infections (such as schistosomiasis) 

Causes by Organ System

Cardiovascular	Cardiac cirrhosis, Right sided cardiac failure, Constrictive pericarditis, Cor Pulmonale, Tricuspid insufficiency
Chemical / poisoning	Aflatoxin
Dermatologic	Keratitis-ichthyosis-deafness syndrome, Addison-Gull syndrome , Reynolds syndrome , Tricho-hepato-enteric syndrome
Drug Side Effect	Amiodarone, Ethanol, interferon alfacon-1, Isoniazid, Methotrexate, Methyldopa, Sulfasalazine
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Addison-Gull syndrome , Alpha 1-antitrypsin deficiency , Alström syndrome, Autoimmune cholangiopathy, Autoimmune hepatitis, Bearn-Kunkel syndrome , Bile duct stricture, Biliary atresia, Budd-Chiari Syndrome, Caroli disease, Cerebrohepatorenal syndrome, Ceroid storage disease, Cholestasis-oedema syndrome, Norwegian type, Cruveilhier-Baumgarten syndrome, Congenital hepatic fibrosis, Cystic fibrosis, Granulomatous cirrhosis, Hemochromatosis, Hepatic vein thrombosis, Hereditary fructose intolerance, Indian familial childhood cirrhosis, Non-alcoholic steatohepatitis , Primary biliary cirrhosis, Primary sclerosing cholangitis, Reynolds syndrome , Tricho-hepato-enteric syndrome , Wilson disease
Genetic	Abetalipoproteinemia, Alagille syndrome, Alpers disease, Alpha 1-antitrypsin deficiency , Alström syndrome, Berardinelli lipodystrophy syndrome, Carbohydrate deficient glycoprotein syndrome type 1a, Carbohydrate-deficient glycoprotein syndrome type 1b, Caroli disease, Ceroid storage disease , Cholestasis-oedema syndrome, Norwegian type, Congenital hepatic fibrosis, Cystic fibrosis, Fanconi disease, Fructose-1-phosphate aldolase deficiency, Galactosemia, Glycogen storage disease type IV, Haemosiderosis, Hemochromatosis, Hereditary fructose intolerance, Keratitis-ichthyosis-deafness syndrome, autosomal recessive, Polycystic kidney disease, autosomal recessive, Porphyria cutanea tarda type 2 (familial), Sickle cell disease, Tyrosinaemia type 1, Wilson disease
Hematologic	Budd-Chiari Syndrome, Erythropoietic protoporphyria, Fanconi disease, Haemosiderosis, Hepatic vein thrombosis, Porphyria cutanea tarda type 2 (familial), Sickle cell disease, Thalassemia, Tyrosinaemia type 1
Iatrogenic	Bile duct stricture, Graft versus host disease, Parenteral nutrition
Infectious Disease	Fasciola hepatica, Hepatitis B, Hepatitis C, Schistosoma haematobium, Schistosoma japonicum, Schistosoma mansoni, Visceral leishmaniasis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Alpers disease, Cerebrohepatorenal syndrome, Keratitis-ichthyosis-deafness syndrome, autosomal recessive
Nutritional / Metabolic	Abetalipoproteinemia, Carbohydrate deficient glycoprotein syndrome type 1a, Carbohydrate-deficient glycoprotein syndrome type 1b, Ceroid storage disease , Cholesterol ester storage disease, Fructose-1-phosphate aldolase deficiency, Galactosemia, Glycogen storage disease type IV, Hypervitaminosis A, Parenteral nutrition
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	Keratitis-ichthyosis-deafness syndrome, autosomal recessive
Overdose / Toxicity	Acetaminophen overdose
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Cerebrohepatorenal syndrome, Fanconi disease, Polycystic kidney disease, autosomal recessive
Rheum / Immune / Allergy	Autoimmune cholangiopathy, Autoimmune hepatitis, Graft versus host disease, Primary biliary cirrhosis, Primary sclerosing cholangitis, Reynolds syndrome , Sarcoidosis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcoholic liver disease

Causes in Alphabetical Order

• Abetalipoproteinemia
• Acetaminophen overdose
• Addison-Gull syndrome
• Aflatoxin
• Alagille syndrome
• Alcoholic liver disease
• Alpers disease
• Alpha 1-antitrypsin deficiency
• Alström syndrome
• Amiodarone
• Autoimmune cholangiopathy
• Autoimmune hepatitis
• Bearn-Kunkel syndrome
• Berardinelli lipodystrophy syndrome
• Bile duct stricture
• Biliary atresia
• Budd-Chiari Syndrome
• Carbohydrate deficient glycoprotein syndrome type 1a
• Cardiac cirrhosis
• Caroli disease
• Cerebrohepatorenal syndrome
• Ceroid storage disease
• Cholestasis-oedema syndrome, Norwegian type
• Cholesterol ester storage disease
• Congenital hepatic fibrosis
• Constrictive pericarditis
• Cor Pulmonale
• Cruveilhier-Baumgarten syndrome
• Cystic fibrosis
• Erythropoietic protoporphyria
• Ethanol
• Fanconi disease
• Fasciola hepatica
• Fructose-1-phosphate aldolase deficiency
• Galactosemia
• Glycogen storage disease type IV
• Graft versus host disease
• Granulomatous cirrhosis
• Haemosiderosis
• Hemochromatosis
• Hepatic vein thrombosis
• Hepatitis B
• Hepatitis C
• Hereditary fructose intolerance
• Hypervitaminosis A
• Indian familial childhood cirrhosis
• Isoniazid
• Keratitis-ichthyosis-deafness syndrome, autosomal recessive
• Methotrexate
• Methyldopa
• Non-alcoholic steatohepatitis
• Parenteral nutrition
• Polycystic kidney disease, autosomal recessive
• Porphyria cutanea tarda type 2 (familial)
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Reynolds syndrome
• Right sided cardiac failure
• Sarcoidosis
• Schistosomiasis
• Sickle Cell Disease
• Steatohepatitis
• Thalassemia
• Tricho-hepato-enteric syndrome
• Tricuspid insufficiency
• Tyrosinaemia type 1
• Visceral leishmaniasis
• Wilson disease

Differentiating Different Causes of Cirrhosis

Differential Diagnosis	Useful Findings
Alcoholic cirrhosis	History EtOH, AST/ALT > 2
Chronic Hepatits C Virus (HCV)	HCV AB
Primary Biliary Cirrhosis (PBC)	Elevated alk phos, AMA+
Primary sclerosing cholangitis	History inflammatory bowel disease (IBD), ANA or ASMA or P-ANCA+
Autoimmune hepatitis	Hypergammaglobulinemia, ANA/ASMA +
Chronic Hepatitis B Virus	HBsAg+, HBeAg may be +
Hemochromatosis	Family history+, Fe/TIBC and ferritin elevated
Wilson’s disease	Family history+, young age, low ceruloplasmin
Alpha-1-antitrypsin (AAT) deficiency	Family history+, young age, low serum AAT