What are the main causes of cirrhosis?
Cirrhosis may be caused by a wide range of diseases and disorders. Signs of cirrhosis progress gradually, developing over time, ultimately resulting in liver failure if not adequately treated.
The most common causes of cirrhosis include:
- Long-term hepatitis infections (chronic): One of the major causes of liver disease, hepatitis is a viral infection which causes inflammation of the liver. A chronic infection (or one that recurs) can lead to damaged liver cells over a period of several years, resulting in cirrhosis. Of the types, hepatitis B and C are the infections that most commonly causes cirrhosis (worldwide), but hepatitis A and D are also known to result in severe scarring of the liver, although more rarely.
- Chronic alcoholism: Consumption of alcohol causes inflammation to living cells, effectively poisoning them. In excess, this can lead to cells becoming destroyed, resulting in the build-up of scar tissue in the liver. The formation of nodules as a result of cells trying to heal, creates pressure on the liver’s veins. Cirrhosis as a result of excessive alcohol consumption (often consistently for more than a decade) is one of the leading causes around the world (in some places, nearly half of all cases). As a cause, the severity of cirrhosis is fundamentally influenced by the amount of alcohol consumed and the period of time over which this is done. The amount of damage varies from one person to the next, and can also be influenced by familial susceptibility (some family lines are more prone to liver problems).
- Non-alcoholic fatty liver (or steatohepatitis): Fatty build-up in the liver over a prolonged period of time can lead to cirrhosis. Scar tissue which develops as a result is often linked with other conditions such as coronary artery disease, diabetes, obesity, treatment using corticosteroid medications, high cholesterol, hypertension (high blood pressure), metabolic syndrome and protein malnutrition.
- Autoimmune liver disease: Autoimmune infections (which may not have an underlying viral cause) occur when instead of fending off invasive organisms such as bacterium, allergens and viruses, the body’s immune system ‘attacks’ healthy tissues in the body, including the organs (in this case, the liver). Autoimmune hepatitis is one example whereby the body’s immune response malfunctions and fights the normal system of the liver and damages its cells instead of the presence of an infection. Sometimes there may not be any underlying infection and the individual may have a genetic predisposition to autoimmune hepatitis, which may be triggered by some other exposure, such as alcohol.
- Primary biliary cholangitis (formerly known as primary biliary cirrhosis): Blockage of the bile ducts leads to liver cell damage as bile accumulates in the small tubes which carry bile from the liver to the gallbladder and into the intestines. Repetitive inflammation as a result causes cirrhosis. Biliary cirrhosis is more common in women between the ages of 35 and 60, but can also occur in children who are born with a malfunction that results in the bile duct being incompletely formed (known as biliary atresia). One example of a possible blockage is the development of gallstones.
- Toxic substances and infections: Germs and other substances which are toxic to the liver can contribute to scarring and damage. Environmental toxins, poisons, certain prescription and over-the-counter medications (such as acetaminophen, antibiotics and some antidepressants), or reactions to some drugs and long-term infections as a result of bacteria or parasites can all contribute to liver scarring and cirrhosis.
- Inherited (genetic) disorders: Genetic conditions can sometimes interfere with the metabolism process in the liver, or the ability to handle accumulation in the liver such as iron (haemochromatosis) and copper (Wilson’s disease) in the system. Some other types of these disorders include cystic fibrosis, alpha-1 antitrypsin deficiency, glycogen storage disease and galactosemia.
- Cardiac cirrhosis: A back-up of blood that develops as a result of an inability of the heart to pump effectively can also cause damage to the liver cells, as well as swelling and pain. Contributing factors of this kind of congestion in the body include smoking, alcohol or heart muscle infections.
Other causes of cirrhosis include:
- Liver disease
- Primary sclerosing cholangitis (hardening and scarring of the bile ducts)
- Schistosomiasis (infection caused by freshwater parasitic worms, also known as bilharzia)
- Cryptogenic cirrhosis (due to an unidentified cause and normally requiring a liver transplant)