Elevated Liver Enzymes in Young Adult with Weight Loss

Case at a Glance

A 25-year-old patient presents with abnormal liver function tests discovered during routine laboratory work-up in the context of unexplained weight loss. The patient reports minimal alcohol consumption.

Patient's Story

The patient is a 25-year-old individual who sought medical attention due to recent weight loss. They report minimal alcohol consumption and no other significant symptoms at presentation. The patient was concerned about their weight loss and requested laboratory evaluation.

Initial Assessment

Physical examination findings were not documented in the initial presentation. The patient appeared generally well but expressed concern about recent weight loss. No acute distress was noted. Initial vital signs and physical examination details were not provided.

The Diagnostic Journey

Comprehensive metabolic panel and liver function tests were ordered. Results showed normal kidney function (BUN 3.5 mmol/L, creatinine 83 umol/L), normal electrolytes (sodium 138 mmol/L, potassium 4.6 mmol/L, chloride 105 mmol/L), and normal protein levels (total protein 77 g/L, albumin 43 g/L). However, significant hepatic abnormalities were identified: elevated total bilirubin (43.4 umol/L), markedly elevated transaminases (SGOT 125 IU/L, SGPT 272 IU/L), severely elevated GGTP (620 IU/L), and elevated direct bilirubin (18 umol/L). Alkaline phosphatase remained within normal limits (98 IU/L).

Final Diagnosis

Hepatocellular injury with cholestatic features - etiology to be determined pending further investigation.

Treatment Plan

The consulting physician recommended immediate hepatic imaging studies to further evaluate liver architecture and rule out structural abnormalities. Close follow-up with primary care physician was advised for continued monitoring and coordination of additional diagnostic workup as indicated.

Outcome and Follow-up

Patient acknowledged the recommendations and expressed understanding of the need for further evaluation. Follow-up imaging and additional laboratory studies were scheduled. Patient was counseled to avoid hepatotoxic substances and to seek immediate medical attention if symptoms worsen.