Concept:
Long-term alcohol abuse damages the liver in stages, and the question asks which change appears first. The trick is to remember the order in which alcoholic liver disease develops, from the mildest and earliest change to the most severe.
Step 1: When a person drinks heavily over time, the very first thing that happens in the liver is that fat starts to build up inside the liver cells. This stage is called fatty liver (also called hepatic steatosis). It is the earliest change and is usually reversible if the person stops drinking.
Step 2: If drinking continues, the disease moves forward in steps: fatty liver → alcoholic hepatitis (inflammation) → cirrhosis (permanent scarring) → and in some cases hepatocellular carcinoma (liver cancer). Each later stage is more serious and harder to reverse.
Step 3: So among the options, fatty liver is the earliest lesion. Hepatitis, cirrhosis and carcinoma all come later in the sequence.
Answer: Option (3) — Fatty liver.