Hepatology MCQ: Abnormal liver function tests

[sadeek]

A 57-year-old man is evaluated for elevated aminotransferase concentrations detected on evaluation for fatigue. The patient has a history of osteoarthritis, type 1 diabetes mellitus, and hypertension, and his medications are ibuprofen, glargine and lispro insulins, lisinopril, simvastatin, and low-dose aspirin. The patient does not use illicit drugs, alcohol, or tobacco; he has never had a blood transfusion. His mother died of heart failure and a maternal aunt died of cirrhosis of unknown cause.

On physical examination, the patient is afebrile; the blood pressure is 135/81 mm Hg, the pulse rate is 53/min, and the respiration rate is 14/min. The BMI is 27. Cardiopulmonary examination is normal; there are no stigmata of chronic liver disease.

Laboratory studies:
Hemoglobin: 14 g/dL (140 g/L)
Glucose (fasting): 145 mg/dL (8.0 mmol/L)
Bilirubin (total): 1.2 mg/dL (20.5 µmol/L)
Bilirubin (direct): 0.4 mg/dL (6.8 µmol/L)
Aspartate aminotransferase: 75 U/L
Alanine aminotransferase: 88 U/L
Alkaline phosphatase: 120 U/L
Albumin: 4.2 g/dL (42 g/L)
Ferritin: 1267 ng/mL (1267 mg/L)
Transferrin saturation: 75%

Serologic tests for viral hepatitis, antinuclear antibody, anti–smooth muscle antibody, and antimitochondrial antibody are negative. Chest radiography and electrocardiography are normal.

Which of the following is the most appropriate next step in the management for this patient?

A- Deferoxamine therapy
B- Genetic testing for mutations of the HFE gene
C- MRI of the abdomen
D- Phlebotomy



Members check correct answer file posted below

[laowen]

Abnormal liver function tests

[occamsLon]

привет
супер

[Confident]

B) Genetic testing. It is hematochromatosis. Transferrin saturation > 50% and serum ferritin > 400 ng/l. MRI to confirm cirrhosis. Two other options are treatment.

[inaoufi]

B- Genetic testing for mutations of the HFE gene

[garryjoey]

MRI ABDOMEN

[israawael]

Correct answer