You are treating a 38-year-old man whose chief complaint is occasional right upper quadrant pain. Analysis of blood samples shows elevated aspartate transaminase (AST) and alanine transaminase (ALT). History indicates that these same enzymes have shown elevated levels each of the past 3 years during routine blood work in conjunction with his annual physical examination. His history also indicates reflux esophagitis, hypertension, and hyperlipidemia. You order tests for serologic and biochemical markers for viral hepatitis and autoimmune liver disease and other metabolic liver diseases, but these results are negative. The patient has gained 50 lb since the age of 18. He consumes less than 5 standard alcoholic drinks per week. Which of the following is the most likely diagnosis in this case?
A) familial hypercholesterolemia
B) medium-chain acyl-CoA dehydrogenase deficiency
C) nonalcoholic fatty liver disease
D) Refsum disease
E) type 2 diabetes

Question

Quizplus · Accepted Answer

The patient's elevated liver enzymes, history of weight gain, and minimal alcohol consumption suggest nonalcoholic fatty liver disease (NAFLD), which is common in individuals with obesity and metabolic syndrome.  Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world. NAFLD is characterized by fatty infiltration of the liver in the absence of alcohol consumption. One of the most significant contributing factors to the development of NAFLD is insulin resistance in the liver. Additional pathophysiology includes an enhanced state of hepatic oxidative stress and lipid peroxidation, decreased antioxidant defenses, early mitochondrial dysfunction, and iron accumulation.

You Are Treating a 38-Year-Old Man Whose Chief Complaint Is