A 56-year-old man with type 2 diabetes and obesity has ALT 86 U/L and AST 72 U/L for 18 months. He drinks 2 units of alcohol weekly. Ultrasound shows

Question

A 56-year-old man with type 2 diabetes and obesity has ALT 86 U/L and AST 72 U/L for 18 months. He drinks 2 units of alcohol weekly. Ultrasound shows fatty liver. FIB-4 is 3.1 and platelet count is 132 x 10^9/L. What is the most appropriate next step?

Accepted Answer

Refer for fibrosis assessment with transient elastography or hepatology review

Answer

Treat with phlebotomy without iron studies

Answer

Schedule ERCP

Answer

Reassure because ultrasound confirms a benign condition

Answer

Start long-term prednisone

Non-alcoholic steatohepatitis with advanced fibrosis risk — RCPSC IM MCQ

A 56-year-old man with type 2 diabetes and obesity has ALT 86 U/L and AST 72 U/L for 18 months. He drinks 2 units of alcohol weekly. Ultrasound shows fatty liver. FIB-4 is 3.1 and platelet count is 132 x 10^9/L. What is the most appropriate next step?