Gastroenterology MCQ 101

An 18-year old is rejected as a blood donor because his serum ALT is elevated at 160 U/L but tests for HBsAg, anti-HBc, anti-HCV and HCV RNA were negative. He states that he has been told that he had liver abnormalities at least one year earlier. He drinks moderately (half a six-pack of beer daily), and gives a history of adolescent-adjustment problems. On exam he has sunflower cataracts, some tremulousness, spider angiomata, and hepatosplenomegaly. The ALT is 200, AST is 150, serum bilirubin is 1.6 mg/dL, and serum albumin 3.2 g/dL.. The serum uric acid is low. Tests for ANA, ASMA, anti-LKM1, alpha 1-antitrypsin level and phenotype, and repeat tests for markers of viral hepatitis are negative or normal. The serum ceruloplasmin level is at the lower limit of normal. The next step in diagnosis should be: 

A. Slit-lamp examination of corneas

B. 12 week therapeutic trial with prednisone

C. Liver biopsy

D.12 week therapeutic trial with pegylated interferon plus ribavirin