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Question 1 - Category: liver
An asymptomatic 55-year-old female is sent to you for evaluation of continuously elevated liver tests for the last two years. She does not drink. She takes medication for hypercholesterolemia and high blood pressure. She has had no major surgeries. Her physical exam reveals a well built, overweight middle age woman. Her liver span is 16 cm, with no other stigmata of liver disease on physical exam. Available laboratory data from her PCP’s office: ALT= 76 U/L, AST= 60 U/L, Alk. Phos= 200 U/L, Total bilirubin= 0.8 mg/dL, Albumin 3.8 gm/dL, HCV-Ab negative, HBsAg negative, HBcIgG negative, ANA negative, AMA negative. You perform a liver biopsy [see figures]. What is her diagnosis?

A. Wilson’s disease B. Non-alcoholic steatohepatitis C. AMA-negative primary biliary cirrhosis D. Alpha-1 antitrypsin deficiency E. Primary sclerosing cholangitis

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