Approach to Hepatitis B e Antigen Negative Patients with Increased Hepatic Aminotransferase Levels

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You answered:

The patient’s liver enzyme elevation is probably unrelated to his hepatitis B. He may have developed fatty liver disease, and an ultrasound should be ordered to evaluate him for this condition.

This answer is incorrect. Although the prevalence of Non Alcoholic Fatty Liver Disease (NAFLD) has been estimated to exist in more than 15% of the general adult population in the United States, it most often involves obese individuals. In general, NAFLD should be considered in patients with otherwise unexplained elevations in liver enzymes. In this patient, however, who has a normal body mass index, normal fasting lipid profile, and a daily routine containing a moderate amount of aerobic exercise, NAFLD is unlikely.

Choose another answer:

	The patient has most likely developed hepatocellular carcinoma and should be scheduled immediately for a triple phase liver computed tomography (CT) scan.
	The patient likely has a precore or core promoter mutant hepatitis B virus, which could be presumptively diagnosed by obtaining a serum hepatitis B viral load.
	The patient is likely infected with a precore mutant hepatitis B virus, which would best be diagnosed by obtaining a hepatitis B genotype.

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