Question

A 26 - year - old male presents to his general practitioner complaining of malaise, loss of appetite and mild abdominal pain. He has noticed that his urine is darker than usual. On clinical examination, A yellow tint to the skin and whites of the eyes was noticed. The history reveals that he has been unwell for about 10 days, initially with malaise, anorexia, nausea and myalgia and feeling as if he might be getting flu. Although the anorexia and general flu - like feeling are not too bad, the malaise continues, he now has a persistent ache in his right upper quadrant and his urine is much darker than usual. He has had no itch, rash, joint symptoms, enlarged glands or sore throat. He lives with his partner, currently 4 months pregnant, and one child aged 4 years. He has an office job and has not been outside Europe in the previous year. The last time he was abroad was a family holiday to Lanzarote 4 months previously. He does not recall being immunized against hepatitis, knows of no - one with jaundice and does not remember ever being jaundiced. He is on no prescribed medication and drinks little alcohol. He is bisexual and has had one male sexual contact over the last 6 months. He admits to recreational cannabis but denies injecting drug use. Initial baseline hematological and biochemical analysis is as below:

Parameter	Patient value	Normal range
Serum total bilirubin	78 μ mol/L	(1 – 22)
Serum ALT	1780 U/L	(5 – 35)
Serum AST	1200 U/L	(10-40)
Serum alkaline phosphatase	110 U/L	(45 – 105)
Serum urea	6.5 mmol/L	(2.5 – 7.5)
Serum sodium	138 mmol/L	(137 – 144)
Serum potassium	5.4 mmol/L	(3.5 – 4.9)
Haemoglobin	14.5 g/dL	(13 – 18)
White blood cell count DLC: Relative and absolute counts are normal with no atypical cells	8.6 ⋅ 10 9 /L	(4 – 11)
Platelets	145 ⋅ 10 9 /L	(150 – 400)
Prothrombin time	15 s	(11.5 – 15.5)

I need help to analyze and solve this case study

Answer 1

Since patient complains of darker urine and pain in right hypochondrium malaise and icteric eyes so it clearly indicate that patient is having some liver related problem .

As all the test results of the patient are normal except the liver functions that are deranged AST and ALT are high, total bilirubin is raised and since person is not a chronic alcoholic so alcoholic hepatitis, or liver cirrhosis is ruled out.so there are chances of non alcoholic fatty liver disease.

We need to have further radiological imaging of liver and viral markers of hepatitis to reach on diagnosis.

Hope this helps.all the best ?