Although cirrhosis of the liver most often associated with alcohol abuse, it also can result from many causes. Almost any chronic liver disease can lead to cirrhosis. These are some of the causes:

• Alcoholic liver disease
• Chronic hepatitis B, C and D
• Chronic autoimmune hepatitis
• Chronic bile duct diseases (e. g. primary biliary cirrhosis)
• Non-alcoholic steatohepatitis (NASH) (liver inflammation that can be caused by fatty liver)
• Inherited metabolic diseases (e. g. hemochromatosis, Wilson disease)
• Long term exposure to toxins or drugs
• Chronic congestive heart failure

Alcoholic liver disease

The development of cirrhosis depends upon the amount and regularity of alcohol intake. Liver cells are injured by chronic, high levels of alcohol consumption. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates. Alcohol can poison all living cells, causing liver cells to become inflamed and die. The death of liver cells leads your body to form scar tissue around veins of your liver. Healing liver cells form nodules, which also press on the liver veins.

Chronic hepatitis B, C and D

Infection with hepatitis B, C virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

Chronic autoimmune hepatitis

Autoimmune hepatitis is a liver disease caused by an abnormality of the immune system that is found more commonly in women. The abnormal immune activity in autoimmune hepatitis causes progressive inflammation and destruction of liver cells (hepatocytes), leading ultimately to cirrhosis.

Chronic bile duct diseases

Primary biliary cirrhosis (PBC) is a liver disease caused by an abnormality of the immune system that is found mostly in women. The abnormal immunity in PBC causes chronic inflammation and destruction of the small bile ducts within the liver. If these ducts become blocked, the bile backs up and can damage the liver. The liver becomes inflamed, starting the long process of cell damage that leads to cirrhosis.

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.

Inherited metabolic diseases

Inherited (genetic) disorders result in the accumulation of toxic substances in the liver which lead to tissue damage and cirrhosis. In hemochromatosis, patients inherit a tendency to absorb an excessive amount of iron from food. Over time, iron accumulation in different organs throughout the body causes cirrhosis, arthritis, heart muscle damage leading to heart failure. In Wilson disease, there is an inherited abnormality in one of the proteins that controls copper in the body. Over time, copper accumulates in the liver, eyes, and brain.

Long term exposure to toxins or drugs

Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.

Chronic congestive heart failure

When your heart doesn't pump well, blood "backs up" into the liver. This congestion causes damage to your liver. It may become swollen and painful. Later it becomes hard and less painful. The cause of the heart failure may be a heart valve problem, smoking, or infection of the heart muscle or the sac around the heart.