Chronic processes can lead to cirrhosis, typically from decades of inflammation. Multiple chronic diseases (e.g. hep c + ETOH + fatty liver) can co-contribute to cirrhosis. An acute insult (e.g. ETOH, med toxicity) can also be superimposed on chronic cirrhosis to precipitate decompensation (ascites, confusion, other manifestations of liver failure). Or severe acute insult (e.g. hypoperfusion, acetaminophen overdose, other) can lead to acute liver failure.