Int. J. Environ. Res. Public Health 2010, 7 1880 form of alcoholic liver disease and can evolve into cirrhosis. The currently accepted minimum diagnostic criteria for steatohepatitis include steatosis, lobular inflammation, and hepatocellular injury, but fibrosis must be absent. Histologically, hepatocellular injury in fatty liver disease usually occurs in the form of ballooning, but it might also present apoptotic (acidophilic) bodies and lytic necrosis [34]. When there is a good quantity of neutrophils, diagnostic points out to an alcoholic etiology. Another mechanism seems to be sinusoidal collagen formation which results from HSC activation. 5.2. Alcoholic Hepatitis Alcoholic hepatitis is histologically characterized by hepatocellular injury with ballooned hepatocytes. Some of which contain steatosis, whereas others may contain intracellular, amorphous, eosinophilic inclusions called Mallory bodies, which are often surrounded by neutrophils [6]. Hepatic ultrasonography is useful in identifying hepatic abscess, cryptogenic hepatocellular carcinoma, and biliary obstruction, each of which may mimic alcoholic hepatitis. Ultrasonography can also be combined with aspiration of ascites. Doppler flow studies may be useful, since an elevated peak systolic velocity or an increase in the diameter of the hepatic artery may help confirm the diagnosis [3]. 5.3. Fibrosis and Cirrhosis The characteristic pattern of fibrosis in non-cirrhotic patients with steatohepatitis follows a pericellular/perisinusoidal architecture as the result of collagen deposition in the space of Disse (Figure 3) [35]. Perivenular fibrosis, periportal fibrosis, and cirrhosis, are typical features of alcoholic fibrosis and often coexist with the findings of alcoholic hepatitis. Biomarkers are useful in advanced liver injury but almost useless in the diagnosis of earlier tissular changes. Figure 3. Steatosis (black arrows) with lipidic cytoplasmic inclusions, it is reversible as long as the harmful stimulus is removed. Nodules circumscribed by fibrous tissue with collagen deposition (red arrows). Emergent new imaging modalities could provide more detailed information about hepatic tissue or even replace biopsy. However, currently there is no method to overpass the specificity of biopsy which,