Cirrhosis of the Liver: Causes, Risk Factors & Prevention

Cirrhosis = late-stage hepatic fibrosis with nodular regeneration and architectural distortion. Irreversible but progression can be halted.

Major Etiologies

Risk Amplifiers

• Alcohol + HCV (synergistic)
• Obesity + alcohol
• Diabetes + NAFLD

Prevention

• Alcohol: ≤1 drink/day (women), ≤2 (men); abstain if liver disease.
• Weight loss 7–10% reverses NASH fibrosis.
• Vaccinate: Hep A/B (if non-immune).
• Screen: HCV (all adults once), HBV (risk-based), hemochromatosis (family).
• Medication review: hepatotoxic drugs.
• Coffee: 2–3 cups/day associated with ↓ fibrosis progression.

Surveillance Once Cirrhosis Diagnosed

• HCC screening: US ± AFP q6mo.
• Varices: EGD at diagnosis, then q1–3yr.
• Non-invasive fibrosis tracking: FibroScan, FIB-4, ELF.

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• Diffuse Hepatic Parenchymal Disease: Etiologies, Presentation & Management
• Carcinoid Tumors and Alcohol: Risks and Management
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Liver Cancer

• Cirrhosis of the Liver: Understanding Reversibility & Management
• Liver Functions: Detoxification, Metabolism, Storage, Bile Production, and Clotting Regulation
• Understanding Secondary Liver Cancer: Treatment Options & Outlook
• Survival After 70% Liver Resection: Not Possible Due to Vital Functions
• The Liver: Essential Functions for Life - Metabolism & Detoxification
• Cirrhosis of the Liver: Causes, Risk Factors & Prevention
• Liver Cancer Treatment: Why Partial Hepatectomy is Necessary
• Liver Cancer Radiation Therapy: Types, Benefits & Treatment
• Bile: Liver's Digestive Fluid for Fat Emulsification
• Understanding the Liver Systems: Portal, Arterial, Vein & Biliary Systems
• Chopped Liver and Liver Health: Nutritional Analysis and Risks
• Understanding the No-Salt Diet for Liver Cancer: Causes & Types

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Cause	Mechanism	Key Features
Alcohol-associated	Direct hepatotoxicity, oxidative stress, inflammation	AST:ALT >2; steatosis → steatohepatitis → fibrosis
NAFLD/NASH	Insulin resistance → lipotoxicity, inflammation	Metabolic syndrome; now leading cause in West
Chronic HBV/HCV	Immune-mediated injury, viral replication	HCV curable; HBV suppressible; screen high-risk
Autoimmune hepatitis	Loss of tolerance to liver antigens	Female predominance; responds to steroids/azathioprine
Genetic: Hemochromatosis, Wilson, Alpha-1 antitrypsin	Iron/copper accumulation, misfolded protein	Family screening; specific treatments exist
Drug/toxin-induced	Methotrexate, amiodarone, Niacin, herbal (kava, germander)	Dose/idiosyncratic; stop agent