Investigate the young patient with cirrhosis carefully as they may have a treatable cause:
Most likely;
- viral hepatitis – hepatitis C (common)
- metabolic-associated fatty liver disease (common)
- alcohol (common)
- haemochromatosis (uncommon but high frequency Celtic races)
- drug (uncommon)
- autoimmune (uncommon)
Must-not-miss;
- Wilson’s disease
- autoimmune hepatitis
- haemochromatosis
- Budd-Chiari
- α1-antitrypsin deficiency
Causes, mechanistic;
- alcohol
- chronic active hepatitis – HBV / HCV / HDV
- autoimmune cholestatic – primary biliary cirrhosis, secondary biliary cirrhosis, primary sclerosing cholangitis (I/II)
- drugs and toxins – nitrofurantoin, methyldopa; Amanita phalloides (death cap) mushroom, carbon tetrachloride, vinyl chloride, paraquat, Aflatoxins
- Hemochromatosis, Wilson’s disease, α1-antitrypsin deficiency; inherited metabolic disorders
- non-alcoholic steatohepatitis – fatty liver, diabetes mellitus
- congestive – cardiac failure, hepatic vein obstruction (Budd-Chiari syndrome)
Discriminator;
- age
- young – autoimmune
- middle – alcohol, MAFLD, CAH, haemochromatosis
- old – alcohol
- any age – drug
Consider first;
- FBC
- EUC
- LFT
- BGL/HbA1c
- Coags
- a1-antitrypsin level
- Antimitochondrial Antibodies (Primary Biliary Cholangitis)
- hepatic USS
Escalation
- decompensated – ambulance
- MAFLD – Hepatology 1 week
- haemochromatosis – Hepatology 1 week
- alcohol – Hepatology, D&A routine
- viral hepatitis – Hepatology 1 week
- autoimmune – Hepatology 1 week
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Last reviewed: August 20, 2026 – W. Hatzidis
Sources: Rosen and Barkin’s 5-Minute Emergency Medicine Consult
Related: Chronic Liver Disease; Hepatomegaly
