The liver has a limited repertoire in response to injury.
Fatty liver is the initial and most common histologic
response to hepatotoxic stimuli, including excessive
alcohol ingestion. The accumulation of fat within the
perivenular hepatocytes coincides with the location of
alcohol dehydrogenase, the major enzyme responsible
for alcohol metabolism. Continuing alcohol ingestion
results in fat accumulation throughout the entire hepatic
lobule. Despite extensive fatty change and distortion of
the hepatocytes with macrovesicular fat, the cessation
of drinking results in normalization of hepatic architecture
and fat content within the liver. Alcoholic fatty
liver has traditionally been regarded as entirely benign,
but similar to the spectrum of nonalcoholic fatty-liver
disease
(Chap. 309), the appearance of steatohepatitis