Increased Liver Chemistry in an Asymptomatic Patient

A 38-year-old real estate agent presents to the office for evaluation of abnormal liver test results that were noticed when he underwent testing for a new life insurance policy. The patient has no complaints, exercises regularly, and takes no medications. He is married, has 2 young children, and does not smoke. He rarely drinks alcohol. His physical examination reveals no abnormalities. His body mass index is 24 kg/m2. Laboratory evaluation shows an alanine transaminase level of 76 U/L (normal, 10–40 U/L), an aspartate transaminase level of 53 U/L (normal, 10–40 U/L), an alkaline phosphatase level of 110 U/L (normal, 25–100 U/L), an albumin level of 4.3 g/dL, and a total bilirubin level of .7 mg/dL. A complete blood count and coagulation parameters are normal. Retesting 1 month later shows an alanine transaminase level of 71 U/L and an aspartate transaminase level of 50 U/L.