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Mild, asymptomatic elevations (less than five times the upper limit of normal) of alanine transaminase and aspartate transaminase levels are common in primary care. It is estimated that approximately 10% of the U.S. population has elevated transaminase levels. An approach based on the prevalence of diseases that cause asymptomatic transaminase elevations can help clinicians efficiently identify common and serious liver disease. The most common causes of elevated transaminase levels are nonalcoholic fatty liver disease and alcoholic liver disease...

A 58-year-old woman presented with intermittent passage of bright red blood from the rectum, progressive fatigue, and dyspnea. Examination revealed telangiectasias on the labial mucosa and nail folds. Her mother was reported to have frequent epistaxis and similar skin lesions.