Aetiology

• 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