Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• Hepatocyte swelling and necrosis: single or scattered cells showing swelling or "balloon" degeneration. The swelling results from accumulation of intracellular lipid and water, plus proteins that normally would be exported.
• Mallory bodies: Cellular accumulation of cytokeratin intermediates filaments and other proteins. Appear as eosinophilic cellular inclusions. Mallory inclusions are sometimes refereed to as "alcoholic hyalin."
• Neutrophilic infiltration: Neutrophils migrate into the lobule and surround the dying hepatocytes. Especially those with Mallory bodies.  (Show me an example.)
• Fibrosis: Brisk sinusoidal and periportal (around the triads) fibrosis. Accumulates with repeat bouts of acute alcoholic injury.
• Enzyme and bilirubin levels: The laboratory values are just what one sees with any acute hepatic inflammatory process. AST and ALT go up and all the other changes can mimic a new case of viral hepatitis.