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A 42-year-old man with mild elevation in aminotransferases

42 years old | Male

Vignette:

A 42-year-old man is referred to the liver clinic with mild elevation in aminotransferases for several years. He has a medical history significant for obesity, hypertension, and hypercholesterolemia. He does not smoke or drink alcohol and there is no high-risk behavior. He has a family history of premature cardiac disease. He is taking a diuretic and, because of his elevated liver tests, was recommended to discontinue his statin medication several months ago. Other than complaints of mild fatigue, the patient feels well. Exam is notable for a BMI of 37 kg/m², truncal obesity, and mild hepatomegaly.

Summary:

elevation in aminotransferases | obesity | hypertension | hypercholesterolemia | history of premature cardiac disease | taking a diuretic | fatigue | truncal obesity | hepatomegaly

Dx:

Non-Alcoholic Fatty Liver Disease Hepatic steatosis

Ref:

https://online.epocrates.com/diseases/79622/Hepatic-steatosis/Common-Vignette

Rank

Disease

Weight

1 Primary biliary cirrhosis 454.0
2 Non-alcoholic Fatty Liver Disease 414.0
3 Stable ischemic heart disease 408.0
4 Adrenocortical carcinoma 398.0
5 Non-ST-elevation myocardial infarction 361.0
6 Biliary cirrhosis 357.0
7 Hepatocellular carcinoma 354.0
8 Eclampsia 352.0
9 Primary sclerosing cholangitis 350.0
10 Chronic atrial fibrillation 345.0
11 Obstructive Sleep Apnea 345.0
12 Liver Cirrhosis 343.0
13 Gout 337.0
14 Gallstone pancreatitis 326.0
15 ST-elevation myocardial infarction 315.0
16 Colorectal cancer 311.0
17 Preeclampsia 305.0
18 Erectile dysfunction 302.0
19 Cushing syndrome 298.0
20 Infectious mononucleosis 288.0
21 Type 2 Diabetes mellitus 286.0
22 Chronic heart failure 284.0
23 Kidney stones 283.0
24 Chronic Kidney Diseases 281.0
25 Hereditary hemochromatosis 279.0
26 Chronic Hepatitis 275.0
27 Hypertriglyceridemia 265.0
28 Achilles tendon rupture 263.0
29 Autoimmune hepatitis 261.0
30 Acute Pancreatitis 260.0
31 Abnormal uterine bleeding 241.0
32 Achilles tendinopathy 238.0
33 Pyogenic Liver Abscess 232.0
34 pancreatic cancer 222.0
35 Amebic Liver Abscess 214.0
36 Osteoarthritis 214.0
37 Migraine headache in adults 213.0
38 Endometrial cancer 212.0
39 Ischemic stroke 212.0
40 Diabetic Ketoacidosis 211.0
41 Papilledema 207.0
42 Thrombotic thrombocytopenic purpura 205.0
43 Klebsiella pneumoniae liver abscess 203.0
44 Rheumatoid Arthritis 203.0
45 Balanitis 201.0
46 Gallbladder cancer 198.0
47 Alcoholic hepatitis 196.0
48 Sarcoidosis 196.0
49 Deep venous thrombosis 193.0
50 Secondary hypogonadism 191.0
51 Alcoholic Fatty Liver 190.0
52 Diabetic Kidney Disease 190.0
53 Prinzmetal angina 190.0
54 Graves Disease 189.0
55 Acromegaly 188.0
56 Hepatic Encephalopathy 183.0
57 Varicose veins 181.0
58 Acute Liver Failure 180.0
59 Androgenetic alopecia 180.0
60 Hiatus hernia 179.0
61 Cellulitis 179.0
62 Choledocholithiasis 178.0
63 Systemic lupus erythematosus 175.0
64 Stroke 171.0
65 Renal Cell Carcinoma 167.0
66 Liver Abscess 164.0
67 Hypothyroidism 163.0
68 Aortic coarctation 163.0
69 Hemorrhagic stroke 162.0
70 Common cutaneous drug reactions 161.0
71 Gastroesophageal reflux disease 161.0
72 Primary hypogonadism 161.0
73 Multiple Myeloma 161.0
74 Autosomal Recessive Polycystic Kidney Disease 160.0
75 Malaria 160.0
76 Systemic sclerosis 159.0
77 Hemolytic uremic syndrome 156.0
78 Gallstones 154.0
79 Acute Lymphocytic Leukemia in Adults 153.0
80 Acute intermittent porphyria 150.0
81 Carpal Tunnel Syndrome 150.0
82 Polyarteritis nodosa 150.0
83 Acute Hepatitis 149.0
84 Analgesic nephropathy 149.0
85 Aortic Dissection 149.0
86 anterior ischemic optic neuropathy 148.0
87 Alzheimer disease 148.0
88 Acute Lymphoblastic leukemia in children 148.0
89 Glomerulonephritis 147.0
90 Pneumonia 147.0
91 Renal and perinephric abscess 145.0
92 Acute Cholecystitis 144.0
93 Celiac Disease 143.0
94 Breast Cancer 140.0
95 Osteomalacia 139.0
96 Alcoholic Liver Disease 136.0
97 Candidal intertrigo 136.0
98 Transient ischemic attack 136.0
99 Salmonella infection 132.0
100 Hyperaldosteronism 131.0
101 Clostridium difficile infection 130.0
102 Mitral Stenosis 130.0
103 Hepatorenal Syndrome 129.0
104 Hyperparathyroidism 129.0
105 Diabetes Mellitus 128.0
106 Chronic Pancreatitis 128.0
107 Amyloidosis 127.0
108 Emphysematous cholecystitis 126.0
109 Leiomyomas 125.0
110 Addison Disease 125.0
111 Multiple Sclerosis 125.0
112 Cholangiocarcinoma 123.0
113 Intrahepatic Cholestasis 122.0
114 Acne fulminans 122.0
115 Dermatophyte infections 121.0
116 Adrenal Suppression 121.0
117 Kawasaki disease 119.0
118 Budd Chiari Syndrome 117.0
119 Liver disease 117.0
120 Alcoholic Liver Cirrhosis 115.0
121 Psoriasis 115.0
122 Extraintestinal Entamoeba histolytica amebiasis 114.0
123 Aortic stenosis 114.0
124 Insomnia in adults 113.0
125 Granulomatosis with polyangiitis 111.0
126 Asthma 110.0
127 Anemia of chronic disease 110.0
128 Primary Myelofibrosis 109.0
129 Autosomal Dominant Polycystic Kidney Disease 109.0
130 Type 1 Diabetes mellitus 108.0
131 Brucellosis 107.0
132 Acute Myeloid Leukemia in adults 107.0
133 Stable angina 107.0
134 Menopause 106.0
135 Umbilical hernia 106.0
136 Hyperprolactinemia 106.0
137 Central retinal artery occlusion 105.0
138 Ankylosing spondylitis 105.0
139 Psoas Abscess 104.0
140 Cholestasis 103.0
141 Acute heart failure 103.0
142 Non-small cell lung cancer 103.0
143 End Stage Renal Disease 103.0
144 Hyperthyroidism 102.0
145 Wilson disease 101.0
146 Open Angle Glaucoma 100.0
147 Peyronie Disease 100.0
148 Familial Mediterranean fever 99.0
149 Food poisoning 98.0
150 Mesenteric ischemia 98.0
151 Ischemic optic neuropathy 98.0
152 posteriorischemic optic neuropathy 98.0
153 COPD Exacerbation 98.0
154 Autoimmune Pancreatitis 97.0
155 Crohn Disease 97.0
156 Acute fatty liver of pregnancy 96.0
157 Multiple endocrine neoplasia 2B 96.0
158 Tuberculous Peritonitis 96.0
159 Extrahepatic Cholestasis 95.0
160 Toxic multinodular goiter 95.0
161 Rocky Mountain spotted fever 94.0
162 Cataract 94.0
163 Renal Artery Stenosis 94.0
164 Chronic liver disease 93.0
165 Chronic Myeloid Leukemia 92.0
166 Chronic Mitral regurgitation 91.0
167 Painless thyroiditis 90.0
168 Hypercalcemia 90.0
169 Cystic Fibrosis 89.0
170 Multiple endocrine neoplasia 2A 89.0
171 Fibromyalgia 88.0
172 Graves ophthalmopathy 87.0
173 Goiter 86.0
174 Diffuse nontoxic goiter 86.0
175 Cervical goiter 86.0
176 Urinary Tract Obstruction 86.0
177 Obstructive cervical goiters 83.0
178 Hereditary Angioedema 82.0
179 Rotator Cuff Tears 82.0
180 Musculoskeletal lower back pain 82.0
181 Diabetic Neuropathy 82.0
182 Gestational diabetes mellitus 78.0
183 Osteoporosis 78.0
184 Atypical pneumonia 78.0
185 Acne conglobata 78.0
186 Gram-negative folliculitis 78.0
187 Excoriated acne 78.0
188 Heparin-induced thrombocytopenia 78.0
189 Intra-abdominal abscess 78.0
190 Gingivitis 78.0
191 Lung Cancer 77.0
192 Guillain-Barre syndrome 76.0
193 Secondary hyperparathyroidism 76.0
194 biliary SOD 75.0
195 Male factor infertility 75.0
196 Henoch-Schonlein purpura 75.0
197 Typhoid infection 73.0
198 Acute Myeloid Leukemia in children 73.0
199 Amphetamine use disorder 73.0
200 Non-diabetic hypoglycemia 73.0
201 Sialadenitis 72.0
202 Central hypothyroidism 71.0
203 Acute bacterial meningitis in neonates 70.0
204 Acute pyelonephritis in adults 70.0
205 Chronic Clonorchiasis 69.0
206 Ovarian and fallopian tube torsion 69.0
207 Bladder Cancer 69.0
208 Prolactinoma 69.0
209 Hyperosmolar Hyperglycemic state 69.0
210 chronic acalculous cholecystitis 68.0
211 Chronic Lymphocytic Leukemia 68.0
212 Acetaminophen overdose 68.0
213 Rosacea 68.0
214 Chronic pyelonephritis 68.0
215 Candida Balanitis 68.0
216 Oropharyngeal and esophageal candidiasis 68.0
217 Vulvovaginal candidiasis 68.0
218 Oral candidiasis 68.0
219 Premenstrual syndrome 68.0
220 Abetalipoproteinemia 68.0
221 Acute Clonorchiasis 67.0
222 Medullary thyroid cancer 67.0
223 Adrenal crisis 67.0
224 Osteomyelitis 67.0
225 Diabetic Amyotrophy 66.0
226 Spontaneous bacterial peritonitis 66.0
227 Influenza 66.0
228 Chronic fatigue syndrome 65.0
229 Labyrinthitis 64.0
230 Acute respiratory failure 64.0
231 Acute viral meningitis 63.0
232 Anaphylaxis 63.0
233 Ovarian Hyperstimulation Syndrome 62.0
234 Pheochromocytoma 62.0
235 Benign Prostatic Hyperplasia 61.0
236 Toxic thyroid adenoma 60.0
237 Gastroparesis 60.0
238 Shigellosis 60.0
239 Hypoparathyroidism 59.0
240 Acne vulgaris 58.0
241 Pancreatic Pseudocyst 58.0
242 Intestinal Obstruction 58.0
243 Viral pharyngitis 58.0
244 Ulcerative Colitis 56.0
245 Acalculous Cholecystitis 56.0
246 Chronic bacterial prostatitis 56.0
247 Familial adenomatous polyposis syndrome 55.0
248 Unstable angina 55.0
249 Churg-Strauss Syndrome 54.0
250 Cryptococcosis 54.0
251 Insect bites and stings 53.0
252 Migraine 53.0
253 Short bowel syndrome 52.0
254 Gilbert syndrome 51.0
255 Gallbladder Dyskinesia 50.0
256 Bell palsy 50.0
257 Priapism 50.0
258 Dry eye 50.0
259 Animal bites 50.0
260 Autoimmune hemolytic anemia 50.0
261 Pharyngitis 50.0
262 Bacterial pharyngitis 50.0
263 STI HIV Pharyngitis 50.0
264 Herpes pharyngitis 50.0
265 Acute Rhinosinusitis 50.0
266 Chronic pelvic pain in women 50.0
267 Acute viral rhinosinusitis 50.0
268 Acute bacterial rhinosinusitis 50.0
269 Acute bacterial meningitis in adults 49.0
270 Milk-alkali syndrome 48.0
271 Acute Milk-alkali syndrome 48.0
272 Pulmonary Embolism 46.0
273 Xanthelasma 46.0
274 Parkinson disease 46.0
275 Peutz-Jeghers Syndrome 45.0
276 Discogenic low back pain 45.0
277 Acute bacterial meningitis in children 45.0
278 cholestatic liver disease 45.0
279 Toxic Megacolon 45.0
280 Simple kidney cyst 44.0
281 Acute pericarditis 44.0
282 Psychogenic polydipsia 43.0
283 chronic biliary obstruction 42.0
284 Acute disseminated encephalomyelitis 42.0
285 Intrahepatic cholestasis of pregnancy 41.0
286 Foodborne E coli infection 41.0
287 COVID19 41.0
288 Cholera 41.0
289 Ovarian Cancer 41.0
290 Primary ciliary dyskinesia 41.0
291 Allergic rhinitis 41.0
292 Kartagener syndrome 41.0
293 Annular pancreas 40.0
294 Tetanus 40.0
295 Pseudohypoparathyroidism 39.0
296 Campylobacter infection 38.0
297 Ascites 37.0
298 Mirizzi Syndrome 36.0
299 Clonorchiasis 35.0
300 Acute Cholangitis 35.0
301 Anaplastic thyroid cancer 35.0
302 pancreatic SOD 34.0
303 Systemic vasculitis 34.0
304 Candidiasis 34.0
305 Acute Mitral regurgitation 34.0
306 Giardiasis 34.0
307 Nasal polyps 34.0
308 Inflammatory Bowel Diseases 33.0
309 Musculoskeletal sprains and strains 33.0
310 chronic cholestatic liver disease 33.0
311 Acute atrial fibrillation 32.0
312 Acute Bacterial Prostatitis 32.0
313 Bullous pemphigoid 32.0
314 Barrett esophagus 30.0
315 Fibrocystic breasts 30.0
316 Tinea versicolor 30.0
317 Testicular cancer 29.0
318 Achalasia 29.0
319 Chronic Milk-alkali syndrome 28.0
320 Sunburn 28.0
321 Hypogammaglobulinemia 26.0
322 Drowning 26.0
323 Intussusception 26.0
324 Gastrointestinal Hemorrhage 26.0
325 Lower gastrointestinal hemorrhage 26.0
326 Upper gastrointestinal hemorrhage 26.0
327 Aseptic meningitis 26.0
328 Chronic Renal vein thrombosis 25.0
329 Herpes zoster 25.0
330 Gastritis 23.0
331 Substernal goiter 23.0
332 Common cold(adults) 23.0
333 Tinnitus 23.0
334 Subdural hematoma 23.0
335 Gastric cancer 23.0
336 Rotor syndrome 23.0
337 Irritable Bowel Syndrome 23.0
338 Esophagitis 21.0
339 Gallbladder Empyema 21.0
340 Stevens-Johnson syndrome 20.0
341 Intestinal Pseudo Obstruction 20.0
342 Fungal meningitis 20.0
343 Endometritis 20.0
344 Empyema 20.0
345 Genital herpes 20.0
346 Charcot-Marie-Tooth Disease 20.0
347 Travelers diarrhea 20.0
348 Intestinal Entamoeba histolytica amebiasis 20.0
349 Ruptured ectopic pregnancy 20.0
350 Viral Gastroenteritis 19.0
351 Chronic Cholecystitis 18.0
352 Uveitis 18.0
353 Anterior uveitis 18.0
354 Intermediate uveitis 18.0
355 Posterior uveitis 18.0
356 Pan uveitis 18.0
357 Acute cervical spine trauma 18.0
358 Lactose intolerance 18.0
359 Croup 18.0
360 mucosal Eosinophilic gastroenteritis 17.0
361 Muscle Layer Eosinophilic gastroenteritis 17.0
362 Acute peptic ulcer 17.0
363 Duodenal Ulcer 17.0
364 Gastric Ulcer 17.0
365 Chlamydia pneumoniae infection 16.0
366 Motion Sickness 16.0
367 Periorbital and orbital cellulitis 16.0
368 Ichthyosis 15.0
369 Pressure ulcer 15.0
370 Splenic abscess 15.0
371 Acute Appendicitis 15.0
372 Acute perforated appendicitis 15.0
373 Hemorrhoids 15.0
374 Bacterial conjunctivitis 15.0
375 Viral conjunctivitis 15.0
376 Mallory-Weiss syndrome 15.0
377 Dystonia 15.0
378 biliary obstruction 14.0
379 Secondary Peritonitis 14.0
380 Abdominal compartment syndrome 14.0
381 Bacterial gastroenteritis 14.0
382 Ruptured Tuboovarian abscess 14.0
383 Acute otitis media 14.0
384 Nephrogenic diabetes insipidus 14.0
385 Central diabetes insipidus 14.0
386 Laryngeal Cancer 14.0
387 Thyroid lymphoma 13.0
388 Peritoneal dialysis associated peritonitis 13.0
389 Angiodysplasia of the colon 13.0
390 Atopic dermatitis 13.0
391 Portal hypertension 12.0
392 Acute peritonitis 12.0
393 subserosal eosinophilic gastroenteritis 12.0
394 Diverticulitis 12.0
395 Oropharyngeal cancer 11.0
396 Psoriatic arthritis 11.0
397 Paraneoplastic Syndromes 11.0
398 Acute epididymitis 11.0
399 Mitral Valve Prolapse 11.0
400 Endometriosis 10.0
401 Listerial gastroenteritis 10.0
402 Dubin-Johnson syndrome 10.0
403 Acute Bronchitis 9.0
404 Acute Renal vein thrombosis 9.0
405 Zollinger-Ellison Syndrome 9.0
406 Anthrax 9.0
407 Non-cholera Vibrio infections 8.0
408 Eosinophilic gastroenteritis 8.0
409 Miliaria 8.0
410 Pelvic inflammatory disease 8.0
411 Acute pelvic inflammatory disease 8.0
412 Acute Cystitis(Men) 7.0
413 Cystitis 7.0
414 Urinary tract infection 7.0
415 Acute Cystitis(Women) 7.0
416 Splenic Rupture 6.0
417 Common cold(children) 6.0
418 Bed bugs 5.0
419 Pyelonephritis 5.0
420 Pityriasis rosea 5.0
421 Malt lymphoma 3.0
422 Penis Carcinoma 1.0
423 Alopecia areata 1.0
424 Phenylketonuria 0.0
425 Immune thrombocytopenia 0.0
426 Disseminated intravascular coagulation 0.0
427 Narcolepsy 0.0
428 Panic disorder in adults 0.0
429 Orthostatic hypotension 0.0
430 Optic neuritis 0.0
431 Neuropapillitis 0.0
432 Pulmonary regurgitation 0.0
433 Hodgkin lymphoma 0.0