In alcoholic liver disease, the sequence of pathological changes from earliest to most advanced is:

• A Cirrhosis → alcoholic hepatitis → steatosis
• B Steatosis → alcoholic hepatitis (with Mallory-Denk bodies) → cirrhosis ✓
• C Hepatocellular carcinoma → cirrhosis → steatosis
• D Steatosis → cirrhosis → alcoholic hepatitis

Explanation

Alcoholic liver disease progresses through defined stages: (1) steatosis (macrovesicular fat — the earliest and fully reversible change), (2) alcoholic steatohepatitis with balloon degeneration, neutrophilic infiltration, and Mallory-Denk bodies (cytokeratin 8/18 tangles), and (3) fibrosis progressing to micronodular cirrhosis. Each stage can exist independently, and cirrhosis is the major risk factor for hepatocellular carcinoma in this setting.

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

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Written and medically reviewed by the StethoPrep medical team.