A 52-year-old African American female presents to your office toestablish care. She has never had a primary care giver but worksfor a gynecologist. Recently she began to complain of fatigue and afeeling of fullness in her abdomen. The gynecologist performed anexam and noted a mass in the RUQ. She ordered a CT of the abdomenas well as labs and advised the patient to establish with a primarycare provider. Her AST was 159, and her ALT was 171. Her fastingglucose was 289. You do not have a copy of the CT report, but thepatient is very upset and says she does not understand why herliver would be failing. She denies a history of alcohol or druguse. No history of viral hepatitis. On assessment you note that herabdomen is distended. There is no fluid wave or ballottement noted.You note that the liver is square on percussion with an estimatedsize of 16 cm at the midclavicular line. You note the presence ofthe liver edge is prominent when you palpate the liver at the rightanterior costal margin and the patient takes a deep breath.
Based on her labs, your physical assessment, and the patient’sreport of the CT findings, what diagnosis do you suspect? Whatwould you expect to see in the CT report to confirm your suspicion?How would you communicate these findings to the gastroenterologist?What diagnostic testing would you recommend?
