Mr Tan, a 55-year-old gentleman with a history of type 2 diabetes, hypertension and

hyperlipidemia, presents to his GP for fatigue and occasional episodes of abdominal

bloating. On examination, he appears to be overweight, and abdominal examination reveals
mild tenderness in the right upper quadrant with a palpable liver edge. The GP orders a liver
panel that shows mildly raised ALT and AST. He has no history of alcohol consumption.

An US HBS is performed showing evidence of non-alcoholic fatty liver disease. Subsequently,

a liver biopsy is performed showing evidence of non-alcoholic steatohepatitis.

Mr Tan is advised to lose weight through lifestyle modifications including maintaining a

healthy diet and exercise, and is placed on regular follow-up. Despite this, his symptoms
persist and is later found to have developed stigmata of chronic liver disease on physical
examination.

A CT liver is performed showing radiological evidence of cirrhosis. Unfortunately, a mass is

also seen in the liver with features consistent with hepatocellular carcinoma.