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.
