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The page below is a sample from the LabCE course Liver Biopsies: Anatomy and Histological Considerations. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Oil red O (ORO) stain demonstrating lipid content

Alcoholic Liver Disease

A liver biopsy may demonstrate mild to severe alcoholic liver disease. Mild and early onset alcoholic liver disease will demonstrate fatty changes that are reversible if alcohol consumption is discontinued. Fatty changes can be seen histologically three to seven days following consumption of alcohol and persist for up to six weeks depending on the amount of alcohol consumed, however, fatty changes alone is not diagnostic of alcoholic liver disease. Other features that may be present in later stages of alcoholic liver disease include the presence of Mallory hyalin, giant mitochondria (visible on hematoxylin and eosin (H&E) stained tissue), and fibrosis. The image demonstrates the use of Immunohistochemistry staining using CK8/18 (brown DAB) to label hepatocytes & Ubiquitin (fast red) to react with Mallory hyaline bodies in fatty liver disease. The presence of other features present in later stages may lead to a diagnosis of alcoholic hepatitis.
Chronic alcoholic liver disease may result in end stage liver disease, known as cirrhosis. Pathologists must be careful to avoid blaming liver disease on alcoholism and not make a diagnosis based off of clinical history alone if the pathological findings do not correlate. Although in the United States alcohol is the most common cause of end stage liver disease (cirrhosis), the extent of the liver damage is attributed to the duration and quantity of consumption as well as genetic makeup. Alcoholic patients can develop liver disease from other sources such as infection, medication reactions, or surgical disorders.