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A female publican in her 60s presented to clinic with abnormal liver function tests: bilirubin 17 μmol/l (normal range (NR) 0–17 μmol/l), alanine transaminase (ALT) 73 IU/l (NR 0–70 IU/l), alkaline phosphatase (ALP) 463 IU/l (NR 42–128 IU/l), γ glutamyl transferase (GGT) 784 IU/l (NR 2–35 IU/l), albumin 35 g/l (NR 35–50 g/l), prothrombin time (PT) 11.0 s (NR 10–12 s). She was asymptomatic with no history of weight loss or recent travel. She consumed an estimated 20 units of alcohol per week and was not taking any regular medications. Past medical history was unremarkable. The patient’s body mass index was 19 kg/m2. On examination, a 10 cm non–tender liver was palpable. No stigmata of chronic liver disease were present. The full blood count, and urea and electrolytes were normal. Viral hepatitis serology was negative. Autoimmune antibody serology, serum copper, caeruloplasmin and ferritin were normal.
An ultrasound of the abdomen confirmed an enlarged liver, with no focal lesions. Flow within the portal vein and hepatic vein was normal. No abnormalities were demonstrated within the biliary tree. The patient went on to have a computed tomographic (CT) scan of the abdomen (fig 1).
The patient then underwent a percutaneous liver biopsy (fig 2) because of continuing liver function deterioration (bilirubin 13 μmol/l, albumin 34 g/l, ALP 968 IU/l, ALT 25 IU/l, GGT 1067 IU/l, PT 11.7 s).
Comment upon the liver function tests and CT findings
Given the liver biopsy findings, what is the diagnosis?
What further investigations are …