A 22-year-old man is persuaded by his wife to come to you for a general checkup. She hints of concern about alcohol use. He admits to drinking on average three to four beers every night with more on the weekends. He used alcohol rarely until 2 years ago when his brother died. He has never had withdrawal symptoms after several days of abstinence. What would be a practical next step to take that might help you further evaluate the physical consequences of this patient’s drinking?
Correct Answer: Order liver function tests including aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT), and a complete blood count (CBC)
Description: This patient's liver enzymes including AST, ALT, and GGT are likely to be at least mildly elevated. On his CBC, the mean corpuscular volume (MCV) may be elevated due to his chronic alcohol intake. Using these laboratory abnormalities, one can explain to the patient that he has a high likelihood of serious physical consequences if he continues drinking. At-risk drinking is considered more than 14 drinks per week or more than 4 drinks at one setting by a man (7 and 3, respectively, for a woman). An ultrasound or CT scan can detect cirrhosis, but cirrhosis does not occur after only 2 years of heavy alcohol use. Surveillance EGD to detect esophageal varices would be recommended if cirrhosis is documented but would be premature at this point. Alpha-fetoprotein is useful in evaluating a liver mass in a patient with cirrhosis as it is usually elevated in the setting of a hepatocellular carcinoma. A CA-19-9 test is used to follow patients with pancreatic cancer.
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