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+--- Thread: 57-year-old man c abnormal LFT - hopeofglory87 (/showthread.php?tid=380587)
57-year-old man c abnormal LFT - hopeofglory87 - ArchivalUser - 01-26-2009
A 57-year-old man is evaluated because of persistent serum aminotransferase
elevations. Medical history is significant for stage II colon cancer that was resected 6
years ago. There has been no evidence of recurrent cancer. The patient has been taking atorvastatin for 5 years for management of hyperlipidemia. He recently required amoxicillin/clavulanate for treatment of acute sinusitis, which has since resolved. He drinks three or four glasses of wine on weekends. Physical examination discloses only mild hepatomegaly. BMI is 32.
Laboratory Studies
Plasma glucose (fasting) 124 mg/dL (6.88 mmol/L)
Serum low-density-lipoprotein cholesterol 122 mg/dL (3.15 mmol/L)
Serum high-density lipoprotein cholesterol 56 mg/dL (1.45 mmol/L)
Serum triglycerides 185 mg/dL (2.09 mmol/L)
Serum aspartate aminotransferase 92 U/L (was normal 2 years ago and 87 U/L 1 year ago)
Serum alanine aminotransferase 104 U/L (was normal 2 years ago and 106 U/L 1 year ago)
Serum alkaline phosphatase 62 U/L
Serum total bilirubin 0.7 mg/dL (11.97 μmol/L)
Serum albumin 4.5 g/dL (45 g/L)
INR 1.1
CT scan of the abdomen shows low-density hepatic parenchyma.
Which of the following is most likely causing this patient's elevated serum
aminotransferase values?
A Recurrence of colon cancer
B Nonalcoholic fatty liver disease
C Administration of amoxicillin/clavulanate
D Primary biliary cirrhosis
E Alcohol use
0 - ArchivalUser - 01-26-2009
aa??
0 - ArchivalUser - 01-26-2009
ee
0 - ArchivalUser - 01-26-2009
but im also thinking of b (coz he is on statins and they cause hetatotoxicity)???
0 - ArchivalUser - 01-26-2009
bbb, secondary to atorvastatin w/c can cause reversible elevation of >3x of aminotransferase activity. I r/o alcoholic hepatitis due to AST/ALT is not > 1
0 - ArchivalUser - 01-26-2009
cc
0 - ArchivalUser - 01-26-2009
Should be B, 'coz Alcohol ruled out as told above; atorvastatin ruled out 'coz LFT deranged only in last 2 years when he was taking it for 5 years
Nonalcoholic fatty liver disease( NAFLD) is common in Obese, Diabetic and Hyperlipidemic.
0 - ArchivalUser - 01-26-2009
bb