Cirrhosis causes: Difference between revisions

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{{Cirrhosis}}
{{Cirrhosis}}
{{CMG}} ; {{AE}} {{ADI}}
{{CMG}} {{AE}} {{ADI}} {{Cherry}}


==Overview==
==Overview==
There are a wide range of causes for cirrhosis, including [[alcohol abuse]], [[genetic diseases]], [[Heart|cardiac]] causes, [[toxins]], [[viruses]], and [[malnutrition]]. The consequence is the same in all cases with the functional [[liver]] tissue being replaced by [[Fiber|fibrous]] [[scar]] tissue and regenerative [[Nodule (medicine)|nodules]].


== Causes ==
== Causes ==
=== Common Causes ===
=== 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.
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.
* ''[[Alcoholic liver disease]]'' (ALD) Alcohol seems to injure the [[liver]] by blocking the normal metabolism of protein, fats, and carbohydrates. Patients may also have concurrent [[alcoholic hepatitis]] with fever, hepatomegaly, jaundice, and anorexia. AST and ALT are both elevated but less than 300 IU/L with a AST:ALT ratio > 2.0, a value rarely seen in other liver diseases. [[Liver biopsy]] may show hepatocyte necrosis, Mallory bodies, neutrophilic infiltration with perivenular inflammation.
* [[Alcoholic liver disease]]  
* ''Chronic [[hepatitis C]]''. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis. Can be diagnosed with serologic assays that detect hepatitis C antibody or viral RNA. The enzyme immunoassay, EIA-2, is the most commonly used screening test in the US.
* Chronic [[hepatitis C]]
* ''Chronic [[hepatitis B]]''. The [[hepatitis B virus]] is probably the most common cause of cirrhosis worldwide, especially South-East Asia, but it is less common in the United States and the Western world. Hepatitis B causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is dependent on the presence of hepatitis B, but accelerates cirrhosis in co-infection. Chronic hepatitis B can be diagnosed with detection of HBsAG > 6 months after initial infection. HBeAG and HBV DNA are determined to assess whether patient will need antiviral therapy.
* Chronic [[hepatitis B]]  
* ''[[Non-alcoholic fatty liver disease|Non-alcoholic steatohepatitis]]'' (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications. This disorder is similar to that of alcoholic liver disease but patient does not have an alcohol history. Biopsy is needed for diagnosis.
* [[Non-alcoholic fatty liver disease|Non-alcoholic steatohepatitis]] (NASH)
* ''[[Primary biliary cirrhosis]]''. May be asymptomatic or complain of fatigue, pruritus, and non-jaundice skin hyperpigmentation with hepatomegaly. There is prominent alkaline phosphatase elevation as well as elevations in cholesterol and bilirubin. Gold standard diagnosis is antimitochondrial antibodies with liver biopsy as confirmation if showing florid bile duct lesions. It is more common in women.
* [[Primary biliary cirrhosis]]  
* ''[[Primary sclerosing cholangitis]]''. PSC is a progressive cholestatic disorder presenting with pruritus, steatorrhea, fat soluble vitamin deficiencies, and metabolic bone disease. There is a strong association with inflammatory bowel disease (IBD), especially ulcerative colitis. Diagnosis is best with contrast cholangiography showing diffuse, multifocal strictures and focal dilation of [[bile duct]]s, leading to a beaded appearance. Non-specific serum immunoglobulins may also be elevated.
* [[Primary sclerosing cholangitis]]
* ''[[Autoimmune hepatitis]]''. This disease is caused by the immunologic damage to the liver causing inflammation and eventually scarring and cirrhosis. Findings include elevations in serum globulins, especially gamma globulins. Therapy with prednisone +/-azathioprine is beneficial. Cirrhosis due to autoimmune hepatitis still has 10-year survival of 90%+. There is no specific tool to diagnose autoimmune but it can be beneficial to initiate a trial of corticosteroids.
* [[Autoimmune hepatitis]]
* ''[[Hereditary hemochromatosis]]''. Usually presents with family history of cirrhosis, skin hyperpigmentation, diabetes mellitus, pseudogout, and/or cardiomyopathy, all due to signs of [[Iron overload disorder|iron overload]]. Labs will show fasting transferrin saturation of > 60% and ferritin > 300 ng/mL. Genetic testing may be used to identify ''HFE'' mutations. If these are present, biopsy may not need to be performed. Treatment is with [[Venipuncture|phlebotomy]] to lower total body iron levels.
* [[Hereditary hemochromatosis]]
* ''[[Wilson's disease]]''. Autosomal recessive disorder characterized by low serum ceruloplasmin and increased hepatic copper content on liver biopsy. May also have [[Kayser-Fleischer ring]]s in the cornea and altered mental status.
* [[Wilson's disease]]
* ''[[Alpha 1-antitrypsin deficiency]]'' (AAT). Autosomal recessive disorder. Patients may also have COPD, especially if they have a history of [[tobacco smoking]]. Serum AAT levels are low. Recombinant AAT is used to prevent lung disease due to AAT deficiency.
* [[Alpha 1-antitrypsin deficiency]]  
* ''Cardiac cirrhosis''. Due to chronic right sided heart failure which leads to liver congestion.
* [[Cardiac cirrhosis]]
* [[Galactosemia]]
* [[Galactosemia]]
* [[Glycogen storage disease type IV]]
* [[Glycogen storage disease type IV]]
* [[Cystic fibrosis]]
* [[Cystic fibrosis]]
* [[Hard and soft drugs|Drug]]s or [[toxin]]s
* [[Hard and soft drugs|Drug]]s or [[toxin]]s
* Certain parasitic infections (such as [[schistosomiasis]])
* Certain [[Parasitism|parasitic]] [[Infection|infections]] (such as [[schistosomiasis]]) 


===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac cirrhosis]], [[Right sided cardiac failure]],[[Constrictive pericarditis]], [[Cor Pulmonale]], [[Tricuspid insufficiency]]
| style="width:75%" bgcolor="Beige" ; border="1" | [[Cardiac cirrhosis]], [[Right sided cardiac failure]], [[Constrictive pericarditis]], [[Cor Pulmonale]], [[Tricuspid insufficiency]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Aflatoxin]]
| bgcolor="Beige" | [[Aflatoxin]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| [[Keratitis-ichthyosis-deafness syndrome]], [[Addison-Gull syndrome ]], [[Reynolds syndrome ]], [[Tricho-hepato-enteric syndrome ]]
| bgcolor="Beige" | [[Keratitis-ichthyosis-deafness syndrome]], [[Addison-Gull syndrome ]] , [[Reynolds syndrome ]] , [[Tricho-hepato-enteric syndrome ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Amiodarone]], [[Ethanol]], [[Isoniazid]], [[Methotrexate]], [[Methyldopa]]
| bgcolor="Beige" | [[Amiodarone]], [[Ethanol]], [[interferon alfacon-1]], [[Isoniazid]], [[Methotrexate]], [[Methyldopa]], [[Sulfasalazine]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[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]]
| bgcolor="Beige" | [[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]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"|  [[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]]
| bgcolor="Beige" |  [[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]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|  [[Budd-Chiari Syndrome]], [[Erythropoietic  protoporphyria]], [[Fanconi disease]], [[Haemosiderosis]], [[Hepatic vein thrombosis]], [[Porphyria cutanea tarda type 2 (familial)]], [[Sickle cell disease]], [[Thalassemia]], [[Tyrosinaemia type 1]]
| bgcolor="Beige" |  [[Budd-Chiari Syndrome]], [[Erythropoietic  protoporphyria]], [[Fanconi disease]], [[Haemosiderosis]], [[Hepatic vein thrombosis]], [[Porphyria cutanea tarda type 2 (familial)]], [[Sickle cell disease]], [[Thalassemia]], [[Tyrosinaemia type 1]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| [[Bile duct]] [[stricture]], [[Graft versus host disease]], [[Parenteral nutrition]]
| bgcolor="Beige" | [[Bile duct]] [[stricture]], [[Graft versus host disease]], [[Parenteral nutrition]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Fasciola hepatica]], [[Hepatitis B]], [[Hepatitis C]], [[Schistosoma haematobium]], [[Schistosoma japonicum]],[[Schistosoma mansoni]], [[Visceral leishmaniasis]]
| bgcolor="Beige" | [[Fasciola hepatica]], [[Hepatitis B]], [[Hepatitis C]], [[Schistosoma haematobium]], [[Schistosoma japonicum]], [[Schistosoma mansoni]], [[Visceral leishmaniasis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| [[Alpers disease]], [[Cerebrohepatorenal syndrome]], [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
| bgcolor="Beige" | [[Alpers disease]], [[Cerebrohepatorenal syndrome]], [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|  [[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]]
| bgcolor="Beige" |  [[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]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
| bgcolor="Beige" | [[Keratitis-ichthyosis-deafness syndrome, autosomal recessive]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Acetaminophen overdose]]
| bgcolor="Beige" | [[Acetaminophen overdose]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Cerebrohepatorenal syndrome]], [[Fanconi disease]], [[Polycystic kidney disease, autosomal recessive]]
| bgcolor="Beige" | [[Cerebrohepatorenal syndrome]], [[Fanconi disease]], [[Polycystic kidney disease, autosomal recessive]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|  [[Autoimmune cholangiopathy]], [[Autoimmune hepatitis]], [[Graft versus host disease]], [[Primary biliary cirrhosis]], [[Primary sclerosing cholangitis]], [[Reynolds syndrome ]], [[Sarcoidosis]]
| bgcolor="Beige" |  [[Autoimmune cholangiopathy]], [[Autoimmune hepatitis]], [[Graft versus host disease]], [[Primary biliary cirrhosis]], [[Primary sclerosing cholangitis]], [[Reynolds syndrome ]] , [[Sarcoidosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Alcoholic liver disease ]]
| bgcolor="Beige" | [[Alcoholic liver disease ]]
|-
|-
|}
|}
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=== Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
=== Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
*[[Abetalipoproteinemia]]
*[[Abetalipoproteinemia]]
*[[Acetaminophen overdose]]
*[[Addison-Gull syndrome ]]
*[[Aflatoxin]]
*[[Alagille syndrome]]
*[[Alagille syndrome]]
*[[Alcoholic liver disease ]]
*[[Alcoholic liver disease ]]
Line 147: Line 151:
*[[Alpha 1-antitrypsin deficiency ]]
*[[Alpha 1-antitrypsin deficiency ]]
*[[Alström syndrome]]
*[[Alström syndrome]]
*[[Amiodarone]]
*[[Autoimmune cholangiopathy]]
*[[Autoimmune cholangiopathy]]
*[[Autoimmune hepatitis]]
*[[Autoimmune hepatitis]]
*[[Bearn-Kunkel syndrome ]] <ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1813854/#reference-sec</ref>
*[[Berardinelli lipodystrophy syndrome]]
*[[Berardinelli lipodystrophy syndrome]]
*[[Bile duct]] [[stricture]]
*[[Bile duct]] [[stricture]]
Line 155: Line 161:
*[[Carbohydrate deficient glycoprotein syndrome type 1a]]
*[[Carbohydrate deficient glycoprotein syndrome type 1a]]
*[[Cardiac cirrhosis]]
*[[Cardiac cirrhosis]]
* [[Right sided cardiac failure]]
*[[Caroli disease]]
*[[Caroli disease]]
*[[Cerebrohepatorenal syndrome]]
*[[Cerebrohepatorenal syndrome]]
*[[Ceroid storage disease ]]
*[[Cholestasis-oedema syndrome, Norwegian type]]
*[[Cholestasis-oedema syndrome, Norwegian type]]
*[[Cholesterol ester storage disease]]
*[[Cholesterol ester storage disease]]
Line 165: Line 171:
*[[Cruveilhier-Baumgarten syndrome]]
*[[Cruveilhier-Baumgarten syndrome]]
*[[Cystic fibrosis]]
*[[Cystic fibrosis]]
*[[Erythropoietic  protoporphyria]]
*[[Ethanol]]
*[[Ethanol]]
*[[Fanconi disease]] <ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2165837/</ref>
*[[Fasciola hepatica]]
*[[Fasciola hepatica]]
*[[Fructose-1-phosphate aldolase deficiency]] <ref>http://ghr.nlm.nih.gov/condition/hereditary-fructose-intolerance</ref>
*[[Galactosemia]]
*[[Galactosemia]]
*[[Glycogen storage disease type IV]]
*[[Glycogen storage disease type IV]]
*[[Graft versus host disease]]
*[[Graft versus host disease]]
*[[Granulomatous cirrhosis]]
*[[Granulomatous cirrhosis]]
*[[Haemosiderosis]]  
*[[Haemosiderosis]]
*[[Hemochromatosis]]
*[[Hemochromatosis]]
*[[Hepatic vein thrombosis]]
*[[Hepatic vein thrombosis]]
Line 187: Line 196:
*[[Polycystic kidney disease, autosomal recessive]]
*[[Polycystic kidney disease, autosomal recessive]]
*[[Porphyria cutanea tarda type 2 (familial)]]
*[[Porphyria cutanea tarda type 2 (familial)]]
*[[Primary biliary cirrhosis]]  
*[[Primary biliary cirrhosis]]
*[[Primary sclerosing cholangitis]]
*[[Primary sclerosing cholangitis]]
*[[Reynolds syndrome ]] <ref>http://rarediseases.info.nih.gov/GARD/Condition/4697/Reynolds_syndrome.aspx</ref>
*[[Right sided cardiac failure]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
*[[Schistosomiasis]]
*[[Schistosomiasis]]
*[[Sickle Cell Disease]]
*[[Sickle Cell Disease]]
*[[Sickle cell disease]]
*[[Steatohepatitis]]
*[[Steatohepatitis]]
*[[Thalassemia]]
*[[Thalassemia]]
*[[Tricho-hepato-enteric syndrome ]] <ref>http://www.checkorphan.org/disease/tricho-hepato-enteric-syndrome</ref>
*[[Tricuspid insufficiency]]
*[[Tricuspid insufficiency]]
*[[Tyrosinaemia type 1]]
*[[Tyrosinaemia type 1]]
*[[Visceral leishmaniasis]]
*[[Visceral leishmaniasis]]
*[[Wilson disease]]
*[[Wilson disease]]
===Differentiating Different Causes of Cirrhosis===
{|
|- style="background:silver; color:black"
| '''Differential Diagnosis''' || '''Useful Findings'''
|- style="background:silver; color:black"
| '''Alcoholic cirrhosis''' || '''History EtOH, AST/ALT > 2'''
|- style="background:silver; color:black"
| '''Chronic Hepatits C Virus (HCV)''' || '''HCV AB'''
|- style="background:silver; color:black"
| '''Primary Biliary Cirrhosis (PBC)''' || '''Elevated alk phos, AMA+'''
|- style="background:silver; color:black"
| '''Primary sclerosing cholangitis''' || '''History inflammatory bowel disease (IBD), ANA or ASMA or P-ANCA+'''
|- style="background:silver; color:black"
| '''Autoimmune hepatitis''' || '''Hypergammaglobulinemia, ANA/ASMA +'''
|- style="background:silver; color:black"
| '''Chronic Hepatitis B Virus''' || '''HBsAg+, HBeAg may be +'''
|- style="background:silver; color:black"
| '''Hemochromatosis''' || '''Family history+, Fe/TIBC and ferritin elevated'''
|- style="background:silver; color:black"
| '''Wilson’s disease''' || '''Family history+, young age, low ceruloplasmin'''
|- style="background:silver; color:black"
| '''Alpha-1-antitrypsin (AAT) deficiency''' || '''Family history+, young age, low serum AAT'''
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


{{WH}}
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Disease]]


{{WS}}
{{WS}}
{{WH}}

Latest revision as of 20:40, 26 December 2017

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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]

Overview

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.

Causes

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

References

  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
  3. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1813854/#reference-sec
  4. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2165837/
  5. ↑ http://ghr.nlm.nih.gov/condition/hereditary-fructose-intolerance
  6. ↑ http://rarediseases.info.nih.gov/GARD/Condition/4697/Reynolds_syndrome.aspx
  7. ↑ http://www.checkorphan.org/disease/tricho-hepato-enteric-syndrome

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