Alcoholic steatohepatitis (alcoholic hepatitis) shows a number of histologic features, most of which are shared with other conditions.


Histologic features of alcholic steatohepatitis:

(1) macrosteatosis

(2) hepatitis with neurophilic infiltrate, hepatocellular necrosis and Mallory bodies

(3) terminal venule sclerosis (perivenular and pericellular fibrosis, "chicken wire" fibrosis)


The fibrosis may be subtle and require reticulin or trichrome stains to demonstrate.


Differential diagnosis of steatohepatitis:

(1) alcohol

(2) metabolic syndrome with non-alcoholic steatohepatitis (NASH)

(3) drugs


Barriers to diagnosis:

(1) alcohol abstinence prior to liver biopsy may reduce the level of steatosis

(2) denial of alcohol use

(3) concurrent metabolic syndrome or drugs that could explain steatohepatitis


Metabolic markers of alcohol use may be helpful in establishing alcohol misuse.


To read more or access our algorithms and calculators, please log in or register.