Pathological lesions occur in the liver in primary hepatic disorders and in extrahepatic/ systemic diseases with hepatic involvement. Diseases may have acute or chronic manifestations. Comorbidities may exist. Pattern recognition is the mainstay of liver biopsy interpretation. A kaleidoscope of morphological patterns exists. One pattern can be caused by more than one etiology. One etiology can produce more than one pattern. Histopathological findings evolve with disease progression or resolution. Therapy may modify the picture. A 3-step algorithmic approach to liver biopsy reporting is presented. To avoid bias, biopsies are analysed blind initially to arrive at a morphological diagnosis based solely on descriptive histological findings. Differential clinical diagnoses are then prioritized according to ones area of practice. The final diagnosis is rendered after close clinicopathological correlation. The basic morphological patterns are: portal hepatitis; periportal (interface) hepatitis; lobular hepatitis; cholestasis/cholestatic hepatitis; steatosis/steatohepatitis; granulomas/ granulomatous hepatitis; necrosis; fibrosis/cirrhosis; and minimal change. Helpful features include abnormalities in hepatocytes, bile ducts, Kupffer cells, hepatic stellate cells, sinusoids and blood vessels; various pigments; viral inclusions and organisms; and aberrant cells. An exclusionary diagnosis may be just as useful as a definitive one to aid decision-making and further patient management. Best practice depends on dedicated hepatology teamwork.