Definition (Dig Dis 2016;34:374; NEJM 2016;375:767; J Hep 2016;64:717)

  • Definition: fibrosis and regenerative nodules resulting from hepatocellular injury
  • Decompensated = jaundice, variceal bleed, encephalopathy, ascites; worse prognosis


  • Alcohol (~60–70%) and other toxins (eg, arsenic)
  • Viral hepatitis (~10%): chronic HBV, HCV, HDV infection
  • Autoimmune hepatitis: ♀, ↑ IgG, ⊕ ANA, antismooth muscle Ab, anti-LKM-1, anti-LC1
  • Metabolic diseases (~5%): hemochromatosis, Wilson disease, α1-AT deficiency
  • Biliary tract diseases (~5%): primary biliary cholangitis, secondary biliary cirrhosis (calculus, neoplasm, stricture, biliary atresia), primary sclerosing cholangitis
  • Vascular diseases: Budd-Chiari syndrome, R-sided CHF, constrictive ericarditis, SOS