Hepatic steatosis may occur as the first stage of hepatic insufficiency due to which cause?

• A. Alcohol consumption
• B. Viral hepatitis
• C. Autoimmune disease
• D. Biliary obstruction

Answer: (A)

Fatty change in the liver can be the first, reversible stage of alcohol-related liver injury. When alcohol is metabolized in the liver, the NADH/NAD+ ratio rises, shifting metabolism toward fatty acid synthesis and away from fat breakdown. This promotes triglyceride formation and reduces export of fat as VLDL, causing fat to accumulate inside hepatocytes (macrovesicular steatosis). Acetaldehyde and oxidative stress from alcohol further impair mitochondrial function and fat handling, reinforcing the buildup. If alcohol use stops, this steatosis can reverse; ongoing use can progress to alcoholic steatohepatitis, fibrosis, and cirrhosis. The other listed causes—viral hepatitis, autoimmune hepatitis, and biliary obstruction—primarily cause liver injury through inflammation or cholestasis rather than starting with fat accumulation, so steatosis is not the initial hallmark in those conditions.