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Case 1: Mrs J

Mrs. J is a 40-year-old woman presenting with a 10-year history of abnormal liver enzymes, including elevated ALT (90 U/L), AST (60 U/L), and alkaline phosphatase (130 U/L), along with a slightly low platelet count. She has a body mass index (BMI) of 30, indicating obesity, and has been diagnosed with prediabetes. Notably, Mrs. J reports no alcohol consumption.

Despite these persistent abnormalities, Mrs. J remains asymptomatic and has not been previously evaluated for liver disease. Her primary care physician is now concerned about the potential for underlying liver pathology.

Case 2: Mr D

Mr. D is a 55-year-old man with a long-standing history of type 2 diabetes and hypertension. He presents for a routine check-up with his primary care physician. His liver enzymes have always been within the normal range (ALT 29 U/L, AST 25 U/L) and his platelet count is 190,000/µL. However, his alkaline phosphatase is slightly elevated at 130 U/L. He has a body mass index (BMI) of 30, indicating obesity. Mr. D denies any alcohol consumption.

Despite normal liver enzymes and no symptoms of liver disease, Mr. D's physician is concerned about the elevated alkaline phosphatase and his risk factors.

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