Fatty Liver Disease
Steatosis is very common and is associated with numerous conditions, the most common of which are alcoholism and the metabolic syndrome. Others include drugs, viruses, disorders of nutrition, and endocrine, metabolic, and systemic diseases. Steatosis mani
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Fatty Liver Disease
Steatosis is very common and is associated with numerous conditions, the most common of which are alcoholism and the metabolic syndrome. Others include drugs, viruses, disorders of nutrition, and endocrine, metabolic, and systemic diseases. Steatosis manifests histologically as the accumulation of droplets of triglycerides inside the cytoplasm of hepatocytes. The size of these droplets varies from a single large one (macrovesicular steatosis) occupying the cytoplasm almost completely and pushing the nucleus to the periphery, to one or more of medium size (mediovesicular steatosis). The term microvesicular should be used when steatosis manifests as an accumulation of very fine vesicular material, without nuclear displacement, which cannot be differentiated from other accumulations (e.g., glycogen) or cytoplasmic changes (e.g., hydropic degeneration) without the use of special techniques. Microvesicular steatosis usually is associated with a congenital or acquired defect in β-oxidation and severe hepatic dysfunction. Another important distinction is between steatosis and steatohepatitis. The latter is characterised by a constellation of changes (inflammation, degenerative hepatocellular changes, and fibrosis), in addition to steatosis, that delineate the risk of progressive liver injury. Distinction between alcoholic and nonalcoholic steatohepatitis is not straightforward because of a considerable overlap at both the morphologic and clinical levels. Paediatric fatty liver disease is a serious emerging problem in developed countries. The particular pattern of fibrosis progression in steatohepatitis has warranted the design and validation of specific semiquantitative methods of grading and staging.
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Alcoholic Liver Disease
Fig. 5.1 Alcoholic liver disease. This liver explant was removed from a patient with established alcoholic cirrhosis. The cut surface shows a macronodular cirrhosis and an orange-yellowish greasy appearance. Alcohol is the most used and abused agent worldwide and leads to a wide range of physical, psychological, and social problems. There is a full spectrum of alcoholic liver disease, including simple steatosis, alcoholic foamy degeneration, alcoholic hepatitis, cirrhosis, and hepatocellular carcinoma. Simple steatosis is present in at least 90% of people with excessive alcohol consumption. About 20% to 40% and 10% to 20% of these people will progress to alcoholic hepatitis and cirrhosis, respectively. Classically, alcoholic cirrhosis is micronodular in gross appearance. However, micronodular cirrhosis in alcoholic liver disease transforms to macronodular following abstinence.
A.W.H. Chan et al., Atlas of Liver Pathology, Atlas of Anatomic Pathology, DOI 10.1007/978-1-4614-9114-9_5, © Springer Science+Business Media New York 2014
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Fatty Liver Disease
Fig. 5.2 Alcoholic steatosis. Macrovesicular steatosis is located predominantly in the perivenular region. Steatosis is the commonest and earliest pathologic feature of alcoholic liver disease. It first appears in
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