Alcoholic steatohepatitis
Nonalcoholic steatohepatitis
Hepatitis C
Toxins and drugs: methotrexate, halogenated hydrocarbons, niacin, HIV protease inhibitors, glucocorticoids, heavy alcohol use
Nutritional disorders: obesity, diabetes, choline deficiency, systemic carnitine deficiency, celiac disease, kwashiorkor, parenteral nutrition
Lipodystrophy
Wilson disease
Aβ-lipoproteinemia
Inflammatory bowel disease
Weber–Christian disease
Q fever

Microvesicular fat*
Reye syndrome
Parenteral alimentation
Yellow fever
Heat stroke
Toxins and drugs: valproic acid, intravenous tetracycline, toxic shock syndromes, salicylate overdosage in children, Jamaican vomiting disease, FIAU, nucleoside reverse transcriptase inhibitors, mycotoxins
Metabolic diseases: cholesterol ester storage disease, galactosemia, Wolman disease, long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, medium-chain acyl-CoA deficiency
Complications of pregnancy: acute fatty liver of pregnancy, eclampsia, HELLP syndrome

*Microvesicular fatty liver is usually the result of mitochondrial damage and defects in lipid oxidation pathways; however, there is significant overlap with many disorders occasionally producing microvesicular fatty liver.
CoA, coenzyme A; FIAU, fialuridine; HELLP, hemolysis, elevated liver enzymes, and low platelet syndrome; HIV, human immunodeficiency virus.

There is no pathognomonic histological feature of alcoholic liver disease. Mallory bodies are aggregates of perinuclear eosinophilic material once considered diagnostic of alcohol-induced injury. They are present in at least 30% of patients with alcoholic hepatitis or cirrhosis but they are also present in other liver disorders, including Wilson disease, cholestatic liver disease, nonalcoholic steatohepatitis, drug-induced and total parenteral nutrition-induced liver disease.

Management and prognosis

The prognosis for alcoholic liver disease is determined mainly by the pathological stage at presentation and the patient’s ability to abstain from ethanol consumption. The single most important therapeutic intervention is complete avoidance of ethanol consumption. This often requires a multidisciplinary approach, involving social workers, psychiatrists, primary care physicians, hepatologists, and social support groups. No therapy for alcoholic liver disease has any proven benefit if heavy drinking continues.

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