When injury to the liver is acute or damage is limited, the liver can usually repair itself. However, repeated injury or damage occurring over many years can lead to the development of cirrhosis. Causes are wide-ranging but generally fall into one of several categories:
- Alcoholic—excessive alcohol use over time can lead to alcoholic liver disease and cirrhosis.
- Associated with hepatitis, such as viral hepatitis, autoimmune hepatitis and non-alcoholic fatty liver disease (NAFLD)
- Biliary—obstruction and/or damage to bile ducts
- Cardiac—congestive heart failure can eventually cause liver damage and cirrhosis
- Metabolic or inherited—these include diseases such as cystic fibrosis, hemochromatosis, and Wilson disease
- Drug or toxin-related (other than alcohol)
- Unknown—in about 10% of cases of cirrhosis, the cause is not known.
The frequency of these causes varies by population and geographic region. In the United States, about half of the cases of cirrhosis are caused by chronic hepatitis C infection and chronic alcohol abuse (alcoholism).
Chronic hepatitis B infection (sometimes with hepatitis D co-infection) causes a significant number of cases and is a major cause in many parts of the world. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are significant non-infectious causes of cirrhosis, and the frequency of this cause is increasing.