Case history
Case history #1
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.
Case history #2
A 63-year-old woman is admitted to the hospital with new-onset ascites. She has a history of long-standing diabetes and hypertension. She has never formally been given a diagnosis of liver disease. Despite increasing abdominal distension, she has lost 13.5 kg in the last year. Physical exam reveals a lethargic-appearing woman with temporal wasting, massive ascites, and 2+ pitting edema. She has numerous spider nevi over her chest wall and marked palmar erythema.
Other presentations
Patients with no significant medical history undergoing evaluation for other reasons may present with only mild obesity on physical exam. Hepatic steatosis may be noted incidentally on abdominal imaging performed for other indications.
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