Causes of Hepatic Fibrosis

Disorders with direct hepatic effects

Autoimmune hepatitis

Certain storage diseases and inborn errors of metabolism:

• Alpha-1 antitrypsin deficiency

• Copper storage diseases (eg, Wilson disease)

• Fructosemia

• Galactosemia

• Glycogen storage diseases (especially types III, IV, VI, IX, and X)

• Iron-overload syndromes (hemochromatosis)

• Lipid abnormalities (eg, Gaucher disease)

• Peroxisomal disorders (eg, Zellweger syndrome)

• Tyrosinemia

Congenital hepatic fibrosis

Infections:

• Bacterial (eg, brucellosis)

• Parasitic (eg, echinococcosisand schistosomiasis)

• Viral (eg, chronic hepatitis B or C*)

Metabolic dysfunction–associated steatohepatitis (MASH) (formerly known as nonalcoholic steatohepatitis [NASH])*

Primary biliary cholangitis (PBC)

Primary sclerosing cholangitis (PSC)

Disorders affecting hepatic blood flow

Budd-Chiari syndrome

Heart failure

Hepatic sinusoidal obstruction syndrome†

Portal vein thrombosis

Medications and substances with hepatic effects

Alcohol*

AmiodaroneAmiodarone

ChlorpromazineChlorpromazine

IsoniazidIsoniazid

MethotrexateMethotrexate

MethyldopaMethyldopa

Vitamin AVitamin A

Anabolic steroid

Disorders that cause mechanical obstruction

Scarring due to prior liver surgery

Bile duct strictures due to impacted gallstones