What are the causes of a starry sky appearance throughout the liver?

A starry sky appearance in the liver, often described as a "starry sky" or "starry sky liver," is typically caused by the accumulation of fat in liver cells (steatosis) and the presence of fibrosis or cirrhosis. This condition can result from chronic liver diseases, such as alcoholic liver disease or non-alcoholic fatty liver disease (NAFLD). The appearance is due to the contrast between the fatty areas and the surrounding normal liver tissue, often highlighted by imaging techniques or histological examination. Other contributing factors may include inflammation and vascular changes in the liver.