A 45-year-old man is referred for further evaluation after a routine health screening revealed several abnormal laboratory test results. He is currently asymptomatic. There is no history of recent weight gain.

His medical history is only significant for elevated triglyceride levels (~250 mg/dL) detected two years ago. He was asked to make lifestyle modifications but defaulted on follow-up after just one month.

He does not smoke, and only drinks socially, generally not more than 1 to 2 units of alcohol each month. He currently leads a sedentary lifestyle. His laboratory results are as follows:

AST: 55 IU/L (8-48)
ALT: 70 IU/L (7-55)
ALP, Bilirubin, INR: Within normal limits
Fasting plasma glucose: 120 mg/dL (70-110)
Triglycerides: 175 mg/dL (<150)
Total cholesterol, LDL, HDL: within normal limits
Iron studies: within normal limits
CRP, ESR: within normal limits

Select Relevant Investigations
Ultrasound abdomen


There is mild hepatomegaly, with a liver length of 17 cm in the midclavicular line. The liver shows a hyperechoic homogeneous echotexture with occasional hyperechoic focal areas suggestive of fatty infiltration.
Viral hepatitis screen


Negative for hepatitis B and C.
Serum ceruloplasmin levels


278 mg/L (200-400)
Liver biopsy


The biopsy reveals macrovesicular steatosis with a predominantly perivenular distribution.

Select Relevant Management
Exercise and weight reduction
Start fenofibrate
Liver transplantation