Description

A twenty year old female was referred to hospital
by her GP, after he received the results of blood tests
taken earlier in the day. She had presented to him
complaining of malaise, nausea and anorexia over a 3
day period. On the day of referral she had also
become jaundiced with dark urine, but normal stool
colour. There was no abdominal pain. She had no
significant past medical history with no history of
jaundice, liver disease or autoimmune conditions,
and no apparent risk factors for blood-borne
hepatitis infection. There was no relevant family
history. She was taking no prescribed medication,
had not taken any over the counter medication or
herbal remedies. She denied excessive alcohol use or
use of intravenous drugs in the past, although she
was not specifically questioned on the use of other
recreational drugs.
She was a single mother and admitted to being
under considerable stress recently.
On examination she appeared well, apart from
marked jaundice. There were no signs of hepatic
encephalopathy or chronic liver disease. Abdominal
examination revealed mild left upper quadrant
tenderness, but no significant hepatomegaly. Liver
function tests (LFTs) taken by her GP are shown in
Table 1, revealing marked elevation of the Alanine
Transaminase (ALT) (Table 1), with a relatively
preserved albumin. Unfortunately her International
Normalised Ratio (INR) had not been measured.
An Ultrasound of the abdomen demonstrated a
normal size liver with normal contour and texture
with no other abnormality.