Cirrhosis causes

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Cirrhosis Microchapters


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Historical Perspective




Differentiating Cirrhosis from other Diseases

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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]


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.


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.

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 [1] [2]

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


  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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