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Can You Diagnose and Treat These Patients With Liver Abnormalities?

  • Authors: Marlyn Mayo, MD
  • CME / ABIM MOC Released: 6/1/2021
  • Valid for credit through: 6/1/2022
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Target Audience and Goal Statement

This activity is intended for gastroenterologists, primary care physicians, diabetologists, and endocrinologists.

The goal of this activity is to improve the ability of clinicians to diagnose and treat patients with primary biliary cholangitis (PBC) liver abnormalities.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Selecting diagnostic tests to evaluate liver abnormalities
    • Ordering evidence-based treatments for PBC
    • Tailoring treatments according to patient characteristics and disease progression


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  • Marlyn Mayo, MD

    Program Director, Gastroenterology Fellowship Program
    Professor of Internal Medicine
    UT Southwestern Medical Center
    Dallas, Texas


    Disclosure: Marlyn Mayo, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Cymabay Therapeutics; GlaxoSmithKline; Mallinckrodt; Mirum Pharmaceuticals
    Received grants for clinical research from: Cymabay Therapeutics; Intercept Pharmaceuticals, Inc.; Mallinckrodt; Salix Pharmaceuticals, Inc.; Target PharmaSolutions, Inc.


  • Christina T. Loguidice

    Medical Education Director, Medscape, LLC

CME Reviewer

  • Esther Nyarko, PharmD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

Accreditation Statements

In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

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Can You Diagnose and Treat These Patients With Liver Abnormalities?

Authors: Marlyn Mayo, MDFaculty and Disclosures

CME / ABIM MOC Released: 6/1/2021

Valid for credit through: 6/1/2022


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Jason is a 49-year-old White man who had mildly elevated liver enzymes at his physical exam 1 year earlier. Results from his current physical show they have further increased (Table 1). No other laboratory abnormalities are observed except for a mildly elevated total cholesterol level of 225 mg/dL (normal, < 200 mg/dL), which he plans on managing with diet. He reports some itching, which seems to worsen at night, sometimes making it difficult for him to sleep. As a result, he says he is left feeling a bit fatigued some days.

You refer Jason for ultrasonography and magnetic resonance cholangiopancreatography (MRCP). Neither of these modalities reveals any abnormalities, such as mechanical bile duct obstruction.

Table 1. Jason's Previous and Current Liver Testing Results

  Results 1 Year Earlier Current Results Normal Range
ALP, U/L 130 583 30 to 120
AST, U/L 26 30 10 to 30
ALT, U/L 43 46 10 to 40
Albumin, g/dL 4.3 3.7 3.5 to 5
Bilirubin (total), mg/dL 0.5 0.5 0.3 to 1.2
GGT, U/L 225 650 2 to 30


ALP = alkaline phosphatase; ALT = alanine aminotransferase; AST = aspartate aminotransferase; GGT = γ-glutamyltransferase.
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