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Histologic diagnosis is based on macrovesicular fatty change herring and lobular inflammation, sometimes accompanied by fibrosis and Mallory hyaline bodies. The condition herring is often detected on liver biopsy performed for other reasons, usually in asymptomatic patients who present with a two- to threefold increase in plasma aminotransferase. For diagnosis, negligible alcohol intake must be evident. Microvesicular fatty liver has a pronounced herring presentation, with fatigue, nausea, and vomiting soon followed by jaundice, hypoglycemia, coma, and a disseminated intravascular coagulopathy. Prognosis and Treatment Potentially reversible, macrovesicular fatty liver usually is not in itself harmful. It is reversible even in potentially fatal instances (eg, in fatty liver of pregnancy, early delivery may be lifesaving).
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