What is the cause of this cirrhosis? Male, 65 years old, heavy weight, history of diabetes mellitus, ultrasound suggestive of cirrhosis but normal liver function, routine clinical examination to exclude viral hepatitis, denial of history of alcohol consumption, history of drugs. The pathology of liver puncture was as follows: pathology also confirmed the diagnosis of cirrhosis, and this patient was finally confirmed by pathologists as the cause of non-alcoholic fatty liver. Strangely enough, the common pathology of NAFLD reveals a large number of fatty degenerative hepatocytes, ballooning of hepatocytes and a large amount of perisinusoidal fibrosis, as shown below: Why was this disease diagnosed as NAFLD? It turns out that cirrhosis due to steatohepatitis, whether alcoholic or non-alcoholic, may have residual fibrotic lesions in the perisinusoidal area, and as the disease progresses steatosis becomes less pronounced and the typical manifestations of steatohepatitis are absent. Ballooning degeneration of hepatocytes becomes rare, and a small amount of steatosis granulosa can become a characteristic manifestation of NAFLD. All of these pathological changes were seen in the above patient. What is cryptogenic cirrhosis? Cryptogenic cirrhosis as the name implies is the failure to find a definite cause, i.e. the common causes of alcoholic, autoimmune, viral hepatitis, drug, biliary and metabolic diseases are initially ruled out. A number of foreign literature reports a high incidence of metabolic syndrome component diseases such as diabetes, obesity and hyperlipidemia in patients with cryptogenic cirrhosis, thus presuming that a very large proportion (30-70%) of cryptogenic cirrhosis is caused by non- alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH) develops. In our study, the prevalence of abnormal glucose metabolism in cryptogenic cirrhosis was 53.45%, which is significantly higher than that of hepatitis B cirrhosis (36.59%). The pathological manifestations vary due to different causative factors. The liver varies in size and its surface can be distorted by large regenerative nodules, which can be as large as several centimeters in diameter, with the interstitial liver showing atrophy and fibrosis. The microscopic appearance of the liver shows regenerative nodules of the liver separated by connective tissue. Mononuclear cell infiltration may be present in the portal vein area, but hepatocytes are well preserved and active hepatocyte necrosis or hepatocyte steatosis is rare or absent. Cryptogenic cirrhosis may be asymptomatic for many years and is often discovered accidentally during examination for other diseases. When clinical symptoms do occur, the signs and symptoms usually lack specificity, such as malaise, lethargy or those associated with portal hypertension such as ascites, splenomegaly, hypersplenism, esophageal varices, and hemorrhage. The liver is mostly normal or reduced in size, and an enlarged spleen is common. Ascites, spider nevi and abdominal wall varices may be present, and serum transaminases and bilirubin are usually normal or mildly elevated. Hyperglobulinemia is common and may be the only laboratory test abnormality. In conclusion, cryptogenic cirrhosis is increasingly becoming a common type of cirrhosis. Compared to hepatic cirrhosis B, cryptogenic cirrhosis has a predominance of older patients and a higher prevalence of abnormal glucose metabolism, but there is no difference in the prevalence of other metabolic syndrome-related diseases such as diabetes.