MKSAP: 68-year-old woman with gradually progressive abdominal distention

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. She does not consume alcohol. Her medications are metformin, lisinopril, low-dose aspirin, and simvastatin. On physical examination, vital signs are normal; BMI is 38. Spider angiomata are present. Abdominal examination is limited by obesity, but there is mild abdominal distention consistent with ascites. There is no obvious hepatomegaly or splenomegaly. Laboratory studies: Platelet count 68,000/µL (68 × 109/L) Alanine aminotransferase 54 U/L Aspartate aminotransferase 64 U/L Albumin 3.2 g/dL (32 g/L) Total bilirubin 2 mg/dL (34.2 µmol/L) Direct bilirubin 1.4 mg/dL (24 µmol/L) Urinalysis 1+ protein Which of the following is the most appropriate next step in management? A: Echocardiogram B: Liver biopsy C: Stop simvastatin D: Ultrasound of the liver and spleen Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs