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In this case, alcohol abuse (toxin) is the most likely etiologic agent.
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* <spoiler text=" What causes hepatocellular steatosis in an alcoholic?"> Alcohol induces hepatic steatosis primarily by: * the shunting of normal substrates away from catabolism and toward biosynthesis due to generation of excess NADH by alcohol dehydrogenase,* impaired assembly and secretions of lipoproteins,* and increased peripheral catabolism of fat. Many other factors also come into play.</spoiler>
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