Health & Medical Children & Kid Health

A Fat Kid With a Fatty Liver: Case Challenge

A Fat Kid With a Fatty Liver: Case Challenge

Elevated Liver Enzymes: Figuring It Out

Chief Complaint

Tomas G., a 12-year-old obese male, was referred to the Bambino Gesù Children's Hospital in Rome for evaluation of elevated liver enzyme levels. Tomas had previously sustained a knee injury, and routine preoperative laboratory work had been notable for elevated liver enzyme levels. Blood glucose and lipid status were not evaluated at that time.

Medical History

Tomas had no history of blood transfusion, drug abuse, or hypertension. He had undergone tonsillectomy and adenoidectomy, performed at another hospital, at 6 years of age. The boy denied alcohol intake, and close family members and the family physician, who knew the child well, confirmed this information.

Review of Systems

Review of systems was positive for occasional vomiting: fewer than 2 episodes a month that had begun within the last 3-4 months. The child reported occasional episodes of abdominal pain, described as aching right upper-quadrant pain that was treated with over-the-counter antidiarrheals or antispasmodics as indicated. Both he and his parents were uncertain of when the pain first began but felt that it was "a long time" ago and that it only occurred sporadically.

Family History

The family history was negative for liver disorders. The child's father had hypertension. Both mother and father described themselves as being "somewhat overweight." Tomas had no siblings.

Physical Examination

The child's body weight was 66.5 kg, greater than the 97th percentile for age and 176% above ideal body weight. Height was 150 cm, and body mass index (BMI) was 29.3 kg/m; both of these values were also greater than the 97th percentile.

On physical examination, Tomas was obese. Blood pressure was 97/58 mm Hg, and heart rate was 115 beats/min. The abdomen was obese but soft. The liver was palpable, 2 cm below the right costal margin, with a firm edge. There was no appreciable spleen tip. His mental status was age-appropriate. The remainder of his physical examination was unremarkable.

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