aetiology

Last reviewed 11/2023

  • alcoholic liver disease
  • viral hepatitis - types B, C and delta
  • metabolic:
    • haemochromatosis - primary and secondary
    • Wilson's disease
    • alpha-1 anti-trypsin deficiency
    • type IV glycogenosis }
    • galactosaemia } very rare
    • congenital tyrosinosis }
  • primary biliary cirrhosis; secondary biliary cirrhosis
  • "lupoid" hepatitis / autoimmune chronic active hepatitis
  • hepatic venous outflow obstruction:
    • venoocclusive disease
    • Budd Chiari syndrome
    • "cardiac cirrhosis" from constrictive pericarditis
  • toxins/ drugs e.g. methrotrexate, amiodarone, bush tea
  • intestinal bypass
  • indian childhood cirrhosis - India, SE Asia, Middle East
  • cryptogenic - heterogenous group of unknown origin

Notes:

  • the most common causes are alcohol, 60-80%; viral hepatitis, 10-20%; biliary cirrhosis, 5-10%; haemochromatosis, 5%
  • the frequency of cryptogenic cirrhosis is variable - in the UK, it accounts for about 30% of cases but in other countries such as France and the urban parts of the USA, it is less prevalent and alcohol more so
  • in granulomatous lesions such as brucellosis, sarcoidosis and tuberculosis, fibrosis is not followed by nodular regrowth i.e. not cirrhosis
  • syphilis causes cirrhosis in neonates but not adults
  • schistosomiasis causes fibrosis but not cirrhosis