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A 60-year-old woman with a past medical history of obesity, diabetes

60 years old | Female

Vignette:

A 60-year-old woman with a past medical history of obesity, diabetes, and dyslipidemia is noted to have abnormal liver enzymes with elevated aminotransferases (ALT: 68 U/L, AST: 82 U/L), and normal alkaline phosphatase and bilirubin. She denies significant alcohol consumption, and tests for viral hepatitis and autoimmune markers are negative. An abdominal ultrasound reveals evidence of fatty infiltration of the liver and slight enlargement of the spleen.

Summary:

obesity | diabetes | dyslipidemia | elevated ALT | elevated AST | ultrasound reveal fatty infiltration of the liver | ultrasound reveal slight enlargement of the spleen

Dx:

Liver Cirrhosis Biliary Cirrhosis Primary Biliary Cirrhosis

Ref:

https://online.epocrates.com/diseases/27822/Cirrhosis/Common-Vignette

Rank

Disease

Weight

1 Non-alcoholic Fatty Liver Disease 374.0
2 Hepatocellular carcinoma 308.0
3 Chronic Hepatitis 292.0
4 Biliary cirrhosis 291.0
5 Eclampsia 283.0
6 Non-ST-elevation myocardial infarction 281.0
7 Primary biliary cirrhosis 280.0
8 Primary sclerosing cholangitis 275.0
9 Gallstone pancreatitis 274.0
10 Liver Cirrhosis 271.0
11 Choledocholithiasis 259.0
12 ST-elevation myocardial infarction 259.0
13 Hypertriglyceridemia 250.0
14 Chronic atrial fibrillation 244.0
15 Kidney stones 219.0
16 Type 2 Diabetes mellitus 215.0
17 Alcoholic Fatty Liver 214.0
18 Stable ischemic heart disease 211.0
19 Alcoholic hepatitis 211.0
20 Preeclampsia 208.0
21 Ischemic stroke 200.0
22 Klebsiella pneumoniae liver abscess 196.0
23 Autoimmune hepatitis 192.0
24 Obstructive Sleep Apnea 184.0
25 Acute intermittent porphyria 183.0
26 Chronic Kidney Diseases 182.0
27 Gout 182.0
28 Hepatic Encephalopathy 176.0
29 Acute Liver Failure 174.0
30 Adrenocortical carcinoma 173.0
31 Alcoholic Liver Disease 172.0
32 Deep venous thrombosis 170.0
33 Acute Cholangitis 169.0
34 Erectile dysfunction 168.0
35 Infectious mononucleosis 167.0
36 chronic acalculous cholecystitis 166.0
37 Alcoholic Liver Cirrhosis 164.0
38 Autosomal Recessive Polycystic Kidney Disease 159.0
39 Acute fatty liver of pregnancy 158.0
40 Acute Hepatitis 157.0
41 Achilles tendinopathy 156.0
42 Achilles tendon rupture 156.0
43 Hemolytic uremic syndrome 156.0
44 Pyogenic Liver Abscess 153.0
45 pancreatic cancer 152.0
46 Colorectal cancer 151.0
47 Stroke 151.0
48 Diabetic Amyotrophy 150.0
49 Hereditary hemochromatosis 150.0
50 Breast Cancer 145.0
51 Familial Mediterranean fever 144.0
52 Amebic Liver Abscess 142.0
53 Chronic Lymphocytic Leukemia 137.0
54 Analgesic nephropathy 136.0
55 Gallbladder cancer 135.0
56 Aortic Dissection 135.0
57 Gallstones 134.0
58 Autoimmune Pancreatitis 134.0
59 Common cutaneous drug reactions 134.0
60 Acute Cholecystitis 131.0
61 Androgenetic alopecia 130.0
62 Gallbladder Dyskinesia 130.0
63 Abnormal uterine bleeding 129.0
64 Acute Pancreatitis 128.0
65 Cushing syndrome 128.0
66 Endometrial cancer 128.0
67 Migraine headache in adults 126.0
68 Prinzmetal angina 124.0
69 Primary Myelofibrosis 122.0
70 Psoas Abscess 121.0
71 Renal Cell Carcinoma 118.0
72 Papilledema 117.0
73 Kawasaki disease 117.0
74 Rheumatoid Arthritis 116.0
75 Wilson disease 114.0
76 Emphysematous cholecystitis 113.0
77 Cholestasis 113.0
78 Diabetic Ketoacidosis 110.0
79 Thrombotic thrombocytopenic purpura 110.0
80 Intrahepatic Cholestasis 110.0
81 Hepatorenal Syndrome 110.0
82 biliary SOD 109.0
83 Polyarteritis nodosa 107.0
84 Chronic heart failure 106.0
85 Food poisoning 106.0
86 Acute Lymphocytic Leukemia in Adults 104.0
87 Osteoporosis 103.0
88 Candidal intertrigo 102.0
89 Sarcoidosis 102.0
90 Hiatus hernia 101.0
91 Liver Abscess 101.0
92 Intra-abdominal abscess 101.0
93 Carpal Tunnel Syndrome 100.0
94 Balanitis 100.0
95 Secondary hypogonadism 100.0
96 Cellulitis 100.0
97 Peyronie Disease 100.0
98 Tuberculous Peritonitis 97.0
99 Central retinal artery occlusion 94.0
100 Acetaminophen overdose 94.0
101 Malaria 93.0
102 Acute heart failure 92.0
103 Dermatophyte infections 91.0
104 Gestational diabetes mellitus 90.0
105 Celiac Disease 89.0
106 Acromegaly 88.0
107 Hyperthyroidism 86.0
108 Non-diabetic hypoglycemia 85.0
109 Systemic lupus erythematosus 85.0
110 Mesenteric ischemia 83.0
111 Varicose veins 83.0
112 Non-small cell lung cancer 83.0
113 Ovarian and fallopian tube torsion 82.0
114 Hyperparathyroidism 82.0
115 Diabetic Neuropathy 82.0
116 Cystic Fibrosis 81.0
117 Gastroesophageal reflux disease 80.0
118 Osteoarthritis 80.0
119 Autosomal Dominant Polycystic Kidney Disease 79.0
120 Hypothyroidism 79.0
121 Diabetes Mellitus 78.0
122 Extrahepatic Cholestasis 78.0
123 Graves Disease 77.0
124 Acalculous Cholecystitis 77.0
125 Acne fulminans 76.0
126 Transient ischemic attack 76.0
127 Renal Artery Stenosis 76.0
128 Urinary Tract Obstruction 75.0
129 Multiple Myeloma 75.0
130 Henoch-Schonlein purpura 75.0
131 Brucellosis 74.0
132 Hyperprolactinemia 73.0
133 Cataract 72.0
134 Glomerulonephritis 71.0
135 Atypical pneumonia 71.0
136 Leiomyomas 70.0
137 Renal and perinephric abscess 70.0
138 Open Angle Glaucoma 70.0
139 anterior ischemic optic neuropathy 70.0
140 Tetanus 70.0
141 Acute bacterial meningitis in adults 70.0
142 Graves ophthalmopathy 70.0
143 Intrahepatic cholestasis of pregnancy 69.0
144 Clostridium difficile infection 68.0
145 Diabetic Kidney Disease 68.0
146 Candida Balanitis 68.0
147 Oropharyngeal and esophageal candidiasis 68.0
148 Vulvovaginal candidiasis 68.0
149 Oral candidiasis 68.0
150 Guillain-Barre syndrome 67.0
151 Pulmonary Embolism 66.0
152 Alzheimer disease 65.0
153 Xanthelasma 65.0
154 Chronic liver disease 64.0
155 Gingivitis 64.0
156 Aortic coarctation 64.0
157 Acute Myeloid Leukemia in children 64.0
158 Menopause 63.0
159 Typhoid infection 63.0
160 Rocky Mountain spotted fever 63.0
161 Asthma 61.0
162 Gastroparesis 60.0
163 Ovarian Hyperstimulation Syndrome 60.0
164 Extraintestinal Entamoeba histolytica amebiasis 60.0
165 Mirizzi Syndrome 60.0
166 Hypercalcemia 59.0
167 End Stage Renal Disease 59.0
168 Chronic Pancreatitis 58.0
169 Acute viral meningitis 58.0
170 Acne vulgaris 56.0
171 Acne conglobata 56.0
172 Gram-negative folliculitis 56.0
173 Excoriated acne 56.0
174 Lung Cancer 56.0
175 Anemia of chronic disease 55.0
176 Benign Prostatic Hyperplasia 54.0
177 Stable angina 54.0
178 Salmonella infection 54.0
179 Umbilical hernia 53.0
180 Hyperosmolar Hyperglycemic state 53.0
181 Cholangiocarcinoma 53.0
182 Acute Lymphoblastic leukemia in children 53.0
183 Simple kidney cyst 52.0
184 chronic biliary obstruction 51.0
185 Psoriasis 50.0
186 Osteomalacia 50.0
187 Primary hypogonadism 50.0
188 Pneumonia 50.0
189 Priapism 50.0
190 Ischemic optic neuropathy 50.0
191 posteriorischemic optic neuropathy 50.0
192 Bell palsy 50.0
193 Dry eye 50.0
194 Insomnia in adults 50.0
195 Acute pyelonephritis in adults 50.0
196 Animal bites 50.0
197 COPD Exacerbation 50.0
198 Chronic Myeloid Leukemia 50.0
199 Labyrinthitis 50.0
200 Chronic pyelonephritis 50.0
201 Amphetamine use disorder 49.0
202 Ankylosing spondylitis 48.0
203 Sialadenitis 47.0
204 Viral pharyngitis 47.0
205 Osteomyelitis 46.0
206 Familial adenomatous polyposis syndrome 46.0
207 Toxic thyroid adenoma 46.0
208 Crohn Disease 45.0
209 Peutz-Jeghers Syndrome 45.0
210 Addison Disease 43.0
211 Ulcerative Colitis 43.0
212 Bladder Cancer 43.0
213 Psychogenic polydipsia 43.0
214 Musculoskeletal lower back pain 41.0
215 Unstable angina 41.0
216 Hyperaldosteronism 41.0
217 Acute respiratory failure 41.0
218 pancreatic SOD 41.0
219 Systemic sclerosis 40.0
220 Acute bacterial meningitis in neonates 40.0
221 Adrenal Suppression 39.0
222 Acute Myeloid Leukemia in adults 36.0
223 Spontaneous bacterial peritonitis 36.0
224 Medullary thyroid cancer 35.0
225 Shigellosis 35.0
226 Granulomatosis with polyangiitis 35.0
227 Chronic Cholecystitis 35.0
228 Rotator Cuff Tears 34.0
229 Rosacea 34.0
230 COVID19 34.0
231 Amyloidosis 34.0
232 Candidiasis 34.0
233 Drowning 34.0
234 Foodborne E coli infection 34.0
235 Secondary hyperparathyroidism 33.0
236 Portal hypertension 33.0
237 Splenic abscess 33.0
238 Splenic Rupture 33.0
239 Type 1 Diabetes mellitus 32.0
240 Discogenic low back pain 30.0
241 Male factor infertility 30.0
242 Tinea versicolor 30.0
243 Inflammatory Bowel Diseases 30.0
244 Churg-Strauss Syndrome 29.0
245 Painless thyroiditis 29.0
246 Milk-alkali syndrome 28.0
247 Acute Milk-alkali syndrome 28.0
248 Multiple endocrine neoplasia 2B 27.0
249 Hereditary Angioedema 27.0
250 Prolactinoma 27.0
251 Abetalipoproteinemia 27.0
252 Acute atrial fibrillation 26.0
253 Acute disseminated encephalomyelitis 26.0
254 Cholera 25.0
255 Goiter 25.0
256 Diffuse nontoxic goiter 25.0
257 Toxic multinodular goiter 25.0
258 Cervical goiter 25.0
259 Influenza 24.0
260 biliary obstruction 24.0
261 Pseudohypoparathyroidism 23.0
262 Acute bacterial meningitis in children 23.0
263 Hypogammaglobulinemia 23.0
264 Testicular cancer 23.0
265 Obstructive cervical goiters 22.0
266 Aortic stenosis 21.0
267 Splenic Infarction 21.0
268 Multiple endocrine neoplasia 2A 20.0
269 Acute pericarditis 20.0
270 Intestinal Pseudo Obstruction 20.0
271 Sunburn 20.0
272 Hypoparathyroidism 20.0
273 Clonorchiasis 20.0
274 Chronic Clonorchiasis 20.0
275 Liver disease 20.0
276 Pancreatic Pseudocyst 19.0
277 Achalasia 18.0
278 Central hypothyroidism 18.0
279 Systemic vasculitis 18.0
280 Acute cervical spine trauma 18.0
281 Gastritis 18.0
282 Chronic Renal vein thrombosis 17.0
283 Pheochromocytoma 16.0
284 Adrenal crisis 16.0
285 Ascites 16.0
286 Intussusception 16.0
287 Barrett esophagus 15.0
288 Fibrocystic breasts 15.0
289 Budd Chiari Syndrome 15.0
290 Pressure ulcer 15.0
291 Ichthyosis 15.0
292 Hemorrhagic stroke 15.0
293 Acute Rhinosinusitis 15.0
294 Acute viral rhinosinusitis 15.0
295 Acute bacterial rhinosinusitis 15.0
296 Heparin-induced thrombocytopenia 14.0
297 Mitral Stenosis 14.0
298 Musculoskeletal sprains and strains 14.0
299 Cryptococcosis 13.0
300 Anaphylaxis 13.0
301 Annular pancreas 12.0
302 Substernal goiter 12.0
303 Campylobacter infection 11.0
304 Multiple Sclerosis 11.0
305 Acute epididymitis 11.0
306 Fibromyalgia 11.0
307 Chronic bacterial prostatitis 10.0
308 Insect bites and stings 9.0
309 Tinnitus 9.0
310 Acute Renal vein thrombosis 9.0
311 Common cold(adults) 8.0
312 Non-cholera Vibrio infections 8.0
313 Chronic Milk-alkali syndrome 8.0
314 Anaplastic thyroid cancer 8.0
315 Acute Cystitis(Men) 7.0
316 Cystitis 7.0
317 Urinary tract infection 7.0
318 Acute Cystitis(Women) 7.0
319 Dubin-Johnson syndrome 7.0
320 Thyroid lymphoma 6.0
321 Fungal meningitis 6.0
322 Acute Bronchitis 5.0
323 Bed bugs 5.0
324 Pyelonephritis 5.0
325 Toxic Megacolon 5.0
326 Lactose intolerance 5.0
327 Esophagitis 5.0
328 Bacterial pharyngitis 5.0
329 Allergic rhinitis 5.0
330 Psoriatic arthritis 4.0
331 Paraneoplastic Syndromes 4.0
332 Chlamydia pneumoniae infection 4.0
333 Alopecia areata 3.0
334 Penis Carcinoma 1.0
335 endocarditis 1.0
336 Common cold(children) 1.0
337 Narcolepsy 0.0
338 Oropharyngeal cancer 0.0
339 Panic disorder in adults 0.0
340 Orthostatic hypotension 0.0
341 Acute Clonorchiasis 0.0
342 Immune thrombocytopenia 0.0
343 Phenylketonuria 0.0
344 Disseminated intravascular coagulation 0.0
345 Stevens-Johnson syndrome 0.0
346 Hodgkin lymphoma 0.0
347 Measles 0.0
348 Visceral leishmaniasis 0.0