A 45-year-old chronic alcoholic develops a fatty liver (hepatic steatosis). Which is the earliest and most reversible change occurring in hepatocytes in this condition?

• A Ballooning degeneration with Mallory-Denk bodies
• B Piecemeal necrosis with lymphocytic infiltration
• C Centrilobular fibrosis with sinusoidal collagen deposition
• D Accumulation of lipid droplets (triglycerides) in the cytoplasm ✓

Explanation

Hepatic steatosis (fatty change) represents the earliest and most reversible response to hepatocellular injury — intracellular accumulation of triglycerides as lipid droplets in hepatocyte cytoplasm. This occurs due to increased free fatty acid delivery, impaired beta-oxidation, and decreased VLDL secretion in alcoholic liver disease. Mallory-Denk bodies and ballooning are features of steatohepatitis. Fibrosis represents irreversible damage.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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