A 20-year-old lady presents with frequent urination. She has no abdominal pain, pruritis, fever or jaundice. There is no family history of diabetes.
•Temperature 36.7°C, pulse 66 bpm, BP 100/53mmHg, SaO2 98-100% on RA.
•Alert, no jaundice, no stigmata of chronic liver disease.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable, with no lymph nodes palpable.
•Cardiovascular: HS dual, no murmur.
•Her chest is clear on auscultation.
•Abdominal examination reveals a soft, non-tender abdomen, with no organomegaly.
•No signs of oedema.
•CBC is normal.
•ALP 1375 IU/L (incidental finding).
•ALT 115 IU/L (incidental finding).
•Renal function is normal.
What is your differential diagnosis?
•Hepatocellular disease, e.g. cirrhosis, alcoholic liver disease.
•Infiltrative disease, e.g. tuberculosis, sarcoidosis.
•Primary biliary cirrhosis (PBC).
•Primary sclerosing cholangitis (PSC).
What further history would you enquire?
•Drug history including herbs and over-the-counter medications.
She drinks 3-4 cans of beer per day. She is not taking any regular medications but she admits to using recreational drugs including ketamine.
What further blood tests would you order for the work-up of the underlying aetiology of deranged liver function?