Steatotic liver disease (SLD) is an escalating public health issue globally, necessitating a comprehensive understanding of its diagnosis and management. This chapter delves into the complexities of SLD by addressing pivotal questions that underscore its clinical significance. Recent updates have refined the definitions within the SLD spectrum, emphasizing the need for pathologists to distinguish between macrovesicular and microvesicular steatosis and ballooning categories. The chapter provides an in-depth analysis of histologic features and diagnostic methods, elucidating the grading and staging systems essential for assessing disease severity. It also explores the diagnostic criteria for metabolic dysfunctionassociated steatotic liver disease (MASLD) and its differentiation from alcoholic-induced liver injury (ALD). Additionally, the chapter examines less common causes of SLD, including drug-induced and hereditary factors, offering a holistic view of this multifaceted condition.