Non-alcoholic fatty liver diseaseDownloads

A 20-year-old man presents to the doctor's office for advice on improving his health. He admits to eating mostly junk food, and he knows that he should lose some weight. His daily physical activity is limited to walking around the college campus between classes. Except for an occasional headache for which he takes acetaminophen, he has no health concerns and takes no other medications. He denies smoking and illicit drug use, but admits to occasional beer binge drinking on weekends. He is sexually active with his current girlfriend and regularly uses condoms. His mother has type 2 diabetes mellitus and obesity, while his father has hypertension and hypercholesterolemia. The pulse is 74/min, the respiratory rate is 16/min, and the blood pressure is 130/76 mm Hg. The body mass index (BMI) is 29 kg/m2. Physical examination reveals an overweight young male, and the rest is otherwise unremarkable. The routine lab test results are as follows: Serum Glucose (fasting) 100 mg/dL Serum Electrolytes: Sodium 141 mEq/L Potassium 4.0 mEq/L Chloride 100 mEq/L Cholesterol, total 190 mg/dL HDL-cholesterol 42 mg/dL LDL-cholesterol 70 mg/dL Triglycerides 184 mg/dL Urinalysis: Glucose Negative Ketones Negative Leukocytes Negative Nitrites Negative RBCs Negative Casts Negative Which of the following lifestyle changes would most likely benefit this patient the most?

A 46-year-old woman presents to her primary care provider for itching. She reports that she has always had dry skin but that the itching has gotten significantly worse over the last few years. The patient also endorses fatigue and dull abdominal pain. Her past medical history includes Hashimoto’s thyroiditis, mitral valve prolapse, and osteoarthritis. She takes levothyroxine and ibuprofen for pain in her knees. The patient drinks 2-3 beers per week. She has a 10 pack-year smoking history but quit 15 years ago. She denies any family history of cancer. On physical exam, her sclera are anicteric. Her abdomen is soft and tender to palpation in the right upper quadrant. Her bowel sounds are normal and hepatomegaly is present. A right upper quadrant ultrasound shows no evidence of extrahepatic biliary dilation. Laboratory studies are performed which reveal the following: Aspartate aminotransferase (AST): 76 U/L Alanine aminotransferase (ALT): 57 U/L Alkaline phosphatase: 574 U/L Total bilirubin: 1.6 mg/dL This patient is most likely to have which of the following additional findings?