A 32-year-old man with mild abdominal discomfort and anorexia admits consuming large amounts of alcohol recently. He undergoes a liver biopsy, which shows the light microscopy findings seen in the image below. Which of the following is the most likely cause of this patient's condition?

Question

A 32-year-old man with mild abdominal discomfort and anorexia admits consuming large amounts of alcohol recently.  He undergoes a liver biopsy, which shows the light microscopy findings seen in the image below.  Which of the following is the most likely cause of this patient's condition?

Quizplus · Accepted Answer

Hepatic steatosis is a nonspecific condition characterized by triglyceride accumulation within the hepatocellular cytoplasm. The pathogenesis of alcohol-induced hepatic steatosis appears related primarily to a decrease in free fatty acid oxidation secondary to excess NADH production by the 2 major alcohol metabolism enzymes, alcohol dehydrogenase and aldehyde dehydrogenase. Contributing pathogenetic factors include impaired lipoprotein assembly and secretion and an increase in peripheral fat catabolism. As seen in the image, fatty tissue that is routinely fixed will microscopically demonstrate cytoplasmic vacuoles as the lipid is dissolved during histologic processing. In frozen sections, lipids can be demonstrated by staining with oil red O or Sudan black. (Choice A) Alcohol-induced hepatic steatosis is associated with increased (not decreased) triglyceride synthesis. (Choice C) Increased peripheral fat (not phospholipid) catabolism is associated with alcohol-induced hepatic steatosis. (Choice D) Impaired (not enhanced) lipoprotein assembly is associated with alcohol-induced hepatic steatosis. (Choice E) Alteration of the hepatic NAD/NADH ratio due to alcohol consumption induces fatty liver through inhibition of gluconeogenesis and fatty acid oxidation. (Choice F) Increased glucose uptake into cells occurs when high insulin levels are circulating; this condition is not associated with hepatic steatosis. Educational objective: The pathogenesis of alcohol-induced hepatic steatosis appears related primarily to a decrease in free fatty acid oxidation secondary to excess NADH production by the 2 major alcohol metabolism enzymes, alcohol dehydrogenase and aldehyde dehydrogenase.

A 32-Year-Old Man with Mild Abdominal Discomfort and Anorexia Admits