A 45-Year-Old Man Is Evaluated for Abnormal Liver Tests

A 45-year-old man is evaluated for abnormal liver tests.  The patient has had no nausea, vomiting, diarrhea, or weight loss.  He has no significant medical problems, takes no medications, and has never been hospitalized or received blood transfusions.  The patient consumes 1 or 2 beers during the week and, occasionally, 4 to 6 beers on the weekend.  He does not smoke cigarettes or use illicit drugs.  The patient works in a warehouse and is monogamous with his wife.
Vital signs are within normal limits.  BMI is 30 kg/m².  There is no scleral icterus, lymphadenopathy, or rash.  The abdomen is soft and nontender without hepatosplenomegaly.  The remainder of the physical examination shows no abnormalities.
The most recent laboratory results are as follows:
Repeat liver function testing shows similar results.
What is the most appropriate next step in management of this patient?

A) Advise 10% weight loss and repeat testing
B) Check viral hepatitis serology
C) Order a liver biopsy
D) Recommend alcohol abstinence; repeat testing in 3 months
E) Screen for celiac disease

Correct Answer:

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