What's the Take Home?
A 63-Year-Old Woman With Liver Disease: Epidemiology, Course, and Prognosis
Ronald N. Rubin, MD—Series Editor
Rubin RN. A 63-year-old woman with liver disease: epidemiology, course, and prognosis. Consultant. 2018;58(2):70-71.
A 63-year-old woman presented for further evaluation of possible liver disease. Approximately 8 months previously, she had undergone a routine physical examination with laboratory testing. Although the initial examination findings had been recorded as unremarkable, results of a biochemistry profile had shown her transaminase levels to be elevated to approximately 2 to 3 times the normal reference values. Repeated biochemistry tests had confirmed the findings. Serologic test results were negative for hepatitis C virus (HCV) infection.
Results of a thorough history and physical examination now revealed a several-year history of low-dose statin use and that she has consumed at least 3 glasses of red wine daily with dinner for many years. She was noted to be obese, with a body mass index of 30 kg/m2. There was a question of a firm, nontender liver edge, but her obesity rendered the examination difficult. Laboratory tests at this visit revealed not only elevated transaminases levels, but also borderline-high glucose and hemoglobin A1c levels. Results of a lipid panel were normal. The statin was stopped, and she was advised to lose weight, cease all alcohol intake, and repeat a biochemistry panel in 3 months.
The patient did not undergo the biochemistry testing in 3 months as directed but rather did so 1 week before presenting for her 6-month follow-up visit. The results now revealed persistent elevation of transaminases 2 to 3 times above normal, with a low-normal serum albumin level of 3.6 g/dL. Her weight had not changed since her visit 6 months previously. A detailed history revealed that there had been no change in her alcohol consumption. She was sent for abdominal ultrasonography, which revealed hepatomegaly with steatohepatitis and early cirrhotic changes. Gallbladder sludge was noted incidentally.