23rd July 2023

A 46-year-old woman is referred by her GP. She has a 7-month history of feeling “tired all the time”

A 46-year-old woman is referred by her GP. She has a 7-month history of feeling “tired all the time” and intermittent feelings of nausea. She has a past medical history of coeliac disease and asthma. She is a non-smoker, drinks 8 units of alcohol per week and works as a secondary school teacher.

Her GP did some blood tests, which showed abnormal liver biochemistry and prompted the referral, as shown below:

• AST 244 u/L (1-45 u/L)
• ALT 338 u/L (<34 u/L)
• ALP 140 u/L (30-130 u/L)
• Bilirubin 38μmol (<21μmol)

You arrange some further blood tests for her.

• Haemoglobin 121 g/L (115-165g/L)
• HIV negative
• HCV negative
• HBV negative
• Ferritin 67 (41-400 μg/L)
• IgG 25 g/L (6.0-16.0 g/L)
• IgA 1.0 g/L (0.8-3.0g/L)
• IgM 1.8 g/L (0.4-2.5 g/L)

An ultrasound scan shows normal appearances of the liver.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.