A 9-year-old chubby boy with seasonal allergic reactions is referred to our gastroenterology service for persistently elevated transaminase ranges for six months. His aspartate aminotransferase (AST) stage is 90 U/L (1.5 μkat/L) and alanine aminotransferase (ALT) stage is 103 U/L (1.7 μkat/L). As well as, he has an elevated ldl cholesterol stage (243 mg/dL [6.3 mmol/L]), a low high-density lipoprotein (HDL) ldl cholesterol stage (36 mg/dL [0.9 mmol/L]), and a borderline excessive triglyceride stage (151 mg/dL [1.7 mmol/L]). On presentation he notes ache in the suitable higher quadrant that’s uninteresting, 5 of 10 in severity, and with out aggravating or relieving components. He just lately had three unfastened, nonbloody, nonmucoid stools. He denies nausea, vomiting, chest ache, decrease again ache, urinary frequency, or dysuria. His weight-reduction plan is wealthy in processed meals. His bodily exercise is minimal. He has no house medicines or household historical past of liver illness. Nonetheless, his 38-year-old father has an elevated ldl cholesterol stage and hypertension.
His BMI is between the 90th and 95th percentiles for age. His bodily examination is critical for proper and left higher quadrant tenderness on deep palpation with out guarding or rigidity. He has no hepatosplenomegaly. Weight loss plan and train counseling is supplied. The repeated transaminase ranges are nonetheless elevated. Iron research and ceruloplasmin ranges are regular, and hepatitis panel, anti–easy muscle/mitochondrial antibodies, liver-kidney microsomal antibody, α1-antitrypsin phenotype, and antinuclear antibodies are all detrimental. Stomach ultrasonography exhibits gentle splenomegaly.
Throughout his follow-up go to, the affected person notes epigastric ache and intermittent unfastened stools. His celiac panel is detrimental, and his transaminase and …