It is possible to develop cirrhosis with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing cirrhosis. If you have risk factors for cirrhosis, ask your healthcare provider what you can do to reduce your risk. Even one or two risk factors is reason enough to consult a provider.
Chronic Alcohol Abuse
Although only about a third of chronic alcoholics develop cirrhosis, between 75%-80% of cirrhosis cases could be prevented by eliminating alcohol abuse. Alcoholic cirrhosis usually develops after ten or more years of heavy drinking.
The amount of alcohol consumption that produces cirrhosis varies widely, with as few as 2-4 drinks per day resulting in damage to some people. Compared with men, women appear to be more susceptible to cirrhosis at lower alcohol intakes.
In general, though, the more you drink, the more likely that you will develop cirrhosis. Alcohol is toxic to liver cells. It also damages the liver by altering normal metabolism of proteins, fats, and carbohydrates. Chronic alcoholics also tend to have poor quality diets, which may contribute to the development of cirrhosis.
Chronic Infection with Hepatitis B, C, or D
Some acute viral hepatitis infections become chronic, leading to liver inflammation and injury that, over time, progress to cirrhosis. After alcohol related cirrhosis, the National Digestive Diseases Information Clearinghouse (NDDIC/NIH) notes that chronic "hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States."
Infection with the hepatitis B virus is probably the most common cause of cirrhosis worldwide, although its impact is less pronounced in the US and other western countries. World Health Organization (WHO) statistics show that 2 billion individuals are initially infected with hepatitis B virus, and although the majority recover, "350 million remain infected chronically and become carriers of the virus." Other expert sources state that acute infection with hepatitis B leads to chronic infection in about 5% of persons. The rate of hepatitis B infection is highest among Asians and Pacific Islanders and second highest among non-Hispanic blacks.
Acute infection with hepatitis C becomes chronic in about 80% of infected adults. About 20%-30% of people with chronic hepatitis C will develop cirrhosis, usually over many years. The rate of hepatitis C infection is highest among non-Hispanic blacks.
Hepatitis D infects people who are already infected with hepatitis B.
Acute hepatitis A and hepatitis E do not usually lead to chronic hepatitis and so have little impact on the development of cirrhosis. There can be rare exceptions to any general rule, however.
Nonalcoholic Steatohepatitis (NASH)
In this disorder, fat cells build up in the liver and eventually lead to scarring. This type of hepatitis is associated with diabetes, obesity, high triglyceride blood levels, coronary artery disease, intestinal bypass surgery, and long-term treatment with corticosteroids.
Blocked Bile Ducts
Blockage of the bile ducts causes bile to back up and damage liver tissue. In adults, this can occur with a condition called primary biliary cirrhosis, in which the bile ducts become inflamed, blocked, and scarred.
Bile ducts may also be blocked due to a disease called primary sclerosing cholangitis. It can also occur as a result of gallstones , or as a complication of gallbladder surgery if the ducts are accidentally tied off or injured. It can result from inflammation of the pancreas, called pancreatitis . In infants, blocked bile ducts may result from biliary atresia, a condition in which the bile ducts are injured or totally absent from birth.
Numerous inherited disorders interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances necessary for proper functioning of the body. They include:
An inherited disorder that causes the body to absorb and store too much iron, which builds up in various organs, including the liver, and causes damage.
An inherited disorder that results in excessive copper accumulation in the body, which also can produce liver damage.
Alpha-1 Antitrypsin Deficiency
An inherited deficiency of a protein produced in the liver that normally functions to block the destructive effects of certain enzymes.The conditionmay lead to liver disease (as well as emphysema ).
An inherited disorder characterized by the inability of the body to use the simple sugar galactose. This leads to an accumulation of galactose 1-phosphate, which causes damage to the liver, central nervous system, and various other body systems.
Glycogen Storage Diseases
A group of inherited disorders caused by a lack of one or more enzymes that results in excessive storage of glycogen (a glucose polymer) in the liver and eventual liver damage.
This genetic disorder can result in liver damage, including cirrhosis.
You are more likely to develop cirrhosis as you get older. This is because you have had more years to expose your liver to viruses, toxins, and medical conditions that cause cirrhosis.
The following conditions can lead to liver damage that is severe enough to cause cirrhosis:
Severe adverse reactions to prescription drugs, such as isoniazid and methotrexate
Chronic exposure to environmental toxins such as arsenic
Severe excesses of vitamin A
Repeated episodes of heart failure with liver congestion
The parasitic infection schistosomiasis
American Liver Foundationwebsite. Available at: http://www.liverfoundation.org/. Accessed March 8, 2006.
Hepatits B . World Health Organization; 2002.
National Institute of Diabetes and Digestive and Kidney Diseaseswebsite. Available at: http://www.niddk.nih.gov/. Accessed March 7, 2006.
National Library of Medicine website. Available at: http://www.nlm.nih.gov/. Accessed March 8, 2006.
Last reviewed January 2007 by David L. Horn, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.