05-23-2008, 02:13 PM
A 46-year-old male presents with right upper quadrant fullness. He has been morbidly obese since his early teenage years. He has type 2 diabetes and hypertension. His current medications include glyburide, atenolol, and hydrochlorothiazide. He does not use tobacco, alcohol or drugs. His family history is positive for type 2 diabetes mellitus in his father. His blood pressure is 138/90 mmHg, pulse is 72/min, temperature is 36.7 C (98 F) and respirations are 16/min. His BMI is 45 kg/m2. He has acanthosis over his neck. Examination of his abdomen reveals palpable hepatomegaly. The rest of the examination is unremarkable. Lab studies show:
Albumin 4.0 mg/dL
Total bilirubin 1.0 mg/dL
Direct bilirubin 0.8 mg/dL
Alkaline phosphatase 100 U/L
Aspartate aminotransferase (SGOT) 72 U/L
Alanine aminotransferase (SGPT) 75 U/L
Blood glucose 168 mg/dL
Hepatitis serology, anti mitochondrial antibodies, antinuclear antibodies, serum ceruloplasmin, and transferrin saturation are normal. What is the most likely pathophysiologic mechanism responsible for this patients increased liver transaminases?
A. Decreased lipolysis
B. Increased hepatic glycogen synthesis
C. Insulin resistance
D. Glucagon overproduction
.E Increased glucocorticoid production
Albumin 4.0 mg/dL
Total bilirubin 1.0 mg/dL
Direct bilirubin 0.8 mg/dL
Alkaline phosphatase 100 U/L
Aspartate aminotransferase (SGOT) 72 U/L
Alanine aminotransferase (SGPT) 75 U/L
Blood glucose 168 mg/dL
Hepatitis serology, anti mitochondrial antibodies, antinuclear antibodies, serum ceruloplasmin, and transferrin saturation are normal. What is the most likely pathophysiologic mechanism responsible for this patients increased liver transaminases?
A. Decreased lipolysis
B. Increased hepatic glycogen synthesis
C. Insulin resistance
D. Glucagon overproduction
.E Increased glucocorticoid production