Case History : A 45 year old female complains of fullness in her right hypochondrium

A 45 year old female complains of fullness in her right hypochondrium since 5 months.There is no associated history of pain epigastrium or burning. Her Blood pressure is 140/90 mmHg and there are xanthelasmas on her eyelids.

1. What investigations would you like to perform?

2. What are the findings on ultrasound?

3. What additional investigations would you conduct keeping in mind the ultrasound findings?

4. What is the most likely diagnosis?

5. How will you treat this condition?

Answers in comments.

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1. Investigations to perform:

Blood Cholesterol levels.

Blood sugar levels.

Abdomen ultrasound.

As this patient has moderately high BP and presence of Xanthelasmas, we would measure serum cholesterol levels and blood sugar levels which not uncommonly exist together with hypertension.

Also patient has got fullness of right hypochondrium so it might be a good idea to conduct an ultrasound of abdomen to exclude any hepatic or gall bladder pathology here.

2. Ultrasound findings:

There is increased echogenicity of liver. Usually kidney and liver have equal echogenicity, in this case liver echogenicity is more .

3. Liver function tests , inclusive of Bilirubin, Alanine Transaminase and Alkaline phosphatase. Also it might be a good idea to conduct Hepatitis B and C levels.

4. Fatty Liver / Non alcoholic Steatotic Hepatitis

5. Management :

Low cholesterol diet

Exercise

Eat plenty of fruit and vegetables.