try this - zkadhem

[ArchivalUser]

it gives but it states that she taked alcholo occasionally

[ArchivalUser]

bb

[ArchivalUser]

15. The correct answer is B. An isolated GGT elevation
may be the only laboratory abnormality seen in a clinically
stable alcoholic patient. Although the test is by no
means sensitive enough to use for screening purposes,
an isolated GGT level (relative to alkaline phosphatase
and other liver function tests) should raise the possibility
of alcohol abuse. This patient was recently fired
from work (raising the question why), reports depressive
symptoms, and has rhinophyma, a physical finding
loosely associated with alcohol use. Other drugs that
can cause an isolated GGT elevation include barbiturates
and phenytoin.
Acetaminophen (choice A) toxicity will present with
massive transaminitis, with levels in the thousands. An
isolated GGT elevation, which can indicate early liver
disease, is not consistent with acetaminophen toxicity.
In many patients, amiodarone (choice C) can cause a
moderate increase in serum transaminases and, rarely,
more severe hepatic injury. Hepatomegaly is usually
present, and a transaminitis, not an elevation of
cholestatic markers such as GGT, is more likely.
Atorvastatin (choice D), like all statins, can cause elevations
of liver enzymes, though they often return to
normal. Again, the pattern is a transaminitis, not an
isolated elevation of GGT.
Metformin (choice E), which acts primarily by limiting
hepatic gluconeogenesis, needs to be used cautiously in
patients with liver failure. It is not, however, commonly
associated with hepatic abnormalities.