pathology
Last reviewed 11/2022
Fat accumulates in the hepatocyte causing it to swell. Usually, the fat forms large droplets - macrovesicles - that are apparent within 3 - 7 days of excess alcohol ingestion. Less commonly, small droplets - microvesicles - are formed, indicating more active lipid synthesis by the hepatocyte.
The fatty changes usually occur in zones 3 and 2 of the acinus - i.e. centrizonal and mid-zonal - but in more severe cases, the change is diffuse.
In a minority of cases, collagen is laid down around the cells and around the hepatic veins - pericellular and perivenular fibrosis - which may lead to cirrhosis without an intervening hepatitis.
Occasionally, cholestasis occurs accompanied by hepatocyte necrosis.