Question

A 43 year old teacher returns to her physician after routine lab evaluation revealed elevated liver transaminases with an ALT of 158 U/L and an AST of 108 U/L. The patient has been in her normal state of health, and has no complaints. Past medical history is significant for diabetes mellitus and hypertension, and current medications include metformin and enalapril. The patient denies foreign travel, blood transfusions, or use of over-the-counter or herbal medications. She is a Jehovah's Witness and does not smoke or use alcohol. Physical examination shows a comfortable, obese female. There is no organomegaly, right upper quadrant or abdominal tenderness, jaundice, scleral icterus, asterixis, or spider angiomata. Laboratory evaluation shows the following: Hepatitis A IgM: negative; Hepatitis A IgG: positive; Hepatitis B surface antigen (HBsAg): negative; Hepatitis B surface antibody (HBsAb): positive; Hepatitis B core antibody (HBcAb): negative; Hepatitis C PCR: negative. Which of the following is the most likely explanation for this patient's elevated liver enzymes?

A. Hep A
B. Hep B
C. Adverse effect metformin
D. NASH
E. Alcohol abuse

Answer 1

The most likely explanation for this patient's elevated liver enzymes is non-alcoholic steatohepatitis (NASH), which is characterized by inflammation and liver cell damage caused by fat build-up in the liver.

Step-by-step explanation:

The most likely explanation for this patient's elevated liver enzymes is non-alcoholic steatohepatitis (NASH). NASH is a condition characterized by inflammation and liver cell damage caused by fat build-up in the liver (steatosis) that is not caused by alcohol. It is commonly associated with obesity, diabetes, and hypertension, which this patient has. NASH can cause elevated liver enzymes, such as ALT and AST. Other causes such as hepatitis A, hepatitis B, adverse effects of metformin, and alcohol abuse have been ruled out based on the patient's medical history, physical examination, and laboratory tests.