A 40-year-old G1P0010 presents to the clinic with nausea and vomiting 8 weeks after a spontaneous abortion at 10 weeks gestation. She admits to heavy drinking (7–8 glasses of wine per day) for the last 20 years; however, after the pregnancy loss, she increased her drinking to 8–9 glasses per day. Hepatomegaly, right upper quadrant pain, and jaundice are noted on abdominal examination. The lungs are clear to auscultation with no abnormalities on chest X-ray. Liver function tests are obtained and a biopsy is performed. Which of the following findings is most likely to be true in her condition?
A↑ NADH/NAD+; ALT:AST ≥ 2:1; β-oxidation ↓; β-hydroxybutyrate ↓; lactic acid ↓
B↑ NAD+/NADH; AST:ALT ≥ 2:1; β-oxidation ↑; β-hydroxybutyrate ↓; lactic acid ↓
C↑ NADH/NAD+; AST:ALT ≥ 2:1; β-oxidation ↓; β-hydroxybutyrate ↑; lactic acid ↑
D↑ NADH/NAD+; ALT:AST ≥ 2:1; β-oxidation ↓; β-hydroxybutyrate ↓; lactic acid ↑
E↑ NAD+/NADH; ALT:AST ≥ 2:1; β-oxidation ↑; β-hydroxybutyrate, no change; lactic acid ↓
A 59-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has systemic lupus erythematosus and hypertension. She does not drink alcohol. Her current medications include lisinopril and hydroxychloroquine. She appears malnourished. Her vital signs are within normal limits. Examination shows a soft, nontender abdomen. There is no ascites or hepatosplenomegaly. Serum studies show: Total bilirubin 1.2 mg/dL Alkaline phosphatase 60 U/L Alanine aminotransferase 456 U/L Aspartate aminotransferase 145 U/L Hepatitis A IgM antibody negative Hepatitis A IgG antibody positive Hepatitis B surface antigen positive Hepatitis B surface antibody negative Hepatitis B envelope antigen positive Hepatitis B envelope antibody negative Hepatitis B core antigen IgM antibody negative Hepatitis B core antigen IgG antibody positive Hepatitis C antibody negative Which of the following is the most appropriate treatment for this patient?
APegylated interferon alpha therapy
BTenofovir therapy
CReferral to a liver transplantation center
DReassurance and follow-up
ELamivudine therapy
A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 2 diabetes mellitus. There is no family history of serious illness. He works as an engineer at a local company. He does not smoke. He drinks one glass of red wine every other day. He does not use illicit drugs. His only medication is metformin. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. His vital signs are within normal limits. Examination shows a soft, nontender abdomen. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show an aspartate aminotransferase concentration of 100 U/L and an alanine aminotransferase concentration of 130 U/L. Liver biopsy shows hepatocyte ballooning degeneration, as well as inflammatory infiltrates with scattered lymphocytes, neutrophils, and Kupffer cells. Which of the following is the most likely diagnosis?
ANonalcoholic steatohepatitis
BAutoimmune hepatitis
CViral hepatitis
DPrimary biliary cholangitis
EAlcoholic fatty liver disease
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