Question of the Week

For December 15, 2020

A 65-year-old man returns for follow-up of abnormal liver function tests. He has a history of hypertension that has been well controlled with hydrochlorothiazide. He consumes two to three alcoholic drinks per week, does not smoke, and has no history of recreational drug use. He lives in an apartment with his wife and identified himself as white on the patient intake questionnaire.

On examination, his BMI is 33, his vital signs are within normal limits, and he has no signs of acute or chronic liver disease.

Fasting laboratory testing yields the following results:

Patient value

Reference range

Aspartate aminotransferase (U/liter)

45

0–35

Alanine aminotransferase (U/liter)

65

0–35

Alkaline phosphatase (U/liter)

90

30–120

Direct bilirubin (mg/dL)

0.3

0.1–0.3

Total bilirubin (mg/dL)

0.9

0.3–1.0

Prothrombin time (sec)

12.0

11.1–13.1

Albumin (g/dL)

4.5

3.5–5.5

Glucose (mg/dL)

115

70–100

Total cholesterol (mg/dL)

260

125–200

LDL cholesterol (mg/dL)

170

<130

HDL cholesterol (mg/dL)

30

≥40

Triglycerides (mg/dL)

300

<150

A complete blood count and serum creatinine level are normal. Tests for hepatitis B surface antigen and hepatitis C antibodies are negative.

Which one of the following additional tests is most appropriate for this patient at this time?

Antimitochondrial antibodies
Serum ceruloplasmin
Antinuclear antibodies
Serum ferritin and transferrin saturation
Liver biopsy

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