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  #1  
Old 06-04-2012
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Question what is the dx here ? patient is diabetic with elevated LFT !

A 66-year-old woman comes for her annual physical examination. She reports only mild fatigue. The patient has prediabetes that is managed by diet alone. She takes no medications and drinks one glass of wine each day.

On physical examination, she is afebrile, blood pressure is 132/86 mm Hg, heart rate is 70/min, and BMI is 32. The remainder of the examination is normal.

Laboratory Studies
Hemoglobin

13.1 g/dL
Platelet count

85,000/μL
Glucose (fasting)

119 mg/dL

Normal
Aspartate aminotransferase

138 U/L
Alanine aminotransferase

124 U/L
Alkaline phosphatase

50 U/L
Total bilirubin

0.8 mg/dL
Albumin

3.1 g/dL
Serologic studies for hepatitis A, B, and C

Negative
Transferrin saturation

Normal

Abdominal ultrasonography shows evidence of mild fatty infiltration of the liver.

Which of the following is the most likely diagnosis?

A Acute viral hepatitis
B Alcoholic liver disease
C Hemochromatosis
D Nonalcoholic fatty liver disease
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  #2  
Old 06-04-2012
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Ans B
the pt has IFG not DM and drink every day with AST>ALT (typical)
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Old 06-04-2012
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i think non alcoholic liver dx

in alcoholic liver dx, the AST increases more than the ALT, however in this q the womans AST is normal.

NASH ( non alcoholic steatohepatitis) is xtized by ALT more than ASt and fatty infilteration of liver. is assoc with obesity, DM and hyperlipidemia
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Old 06-04-2012
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I also think this is Non Alcohlic Fatty Liver.

Besides the lab values,1 glass of wine everyday wont cause Alcholic hepatitis (spoken from experience )
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Old 06-04-2012
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B
ast > alt
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D Nonalcoholic fatty liver disease

Obesity, PreDiabetic and AST not at least 1.5 times ALT.
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Old 06-05-2012
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ans is D ! NASH

AST and ALT elevated.

why not alcoholic liver disease? dont know. but one expln is AST:ALT=2:1 in ALD.
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