### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am 37 yrs old, never ever had any health issues at all in my life past the occasional headaches etc. I recently had felt bad for about a week and wen to doctor because my eyes wer turning yellowish color as was my skin . later to find out that it was jaundice due to my alt/glucose to high that cause a high bilirubin in my body as well. I was put into our local hospital immediatley due to high alt 185 . i am not a drinker at all or smoker, so they did all tes to discover problem i was having to have the issues from liver etc.They have checked everything at that point as far as all abdomen scans, mri, ct scans, even a scan you use on pregnant women. found nothing obstructing bile ducts.so i am confused as to what would cause such levels ? so i just had a liver biopsy done two days ago, waiting on results ?  just out of curiosity would a cream called trtriamcinolone acetonide cause any of this at all, only med i have used and its a cream ? or any ideas as to what could cause such liver alt elevations ?

### output:

Hi, I hope you are very well. The study of alterations in hepatic chemistry consists of:1. Know the type of enzyme and pattern of elevation, you comment that you only present an increase in ALT levels, so we can infer that it is a hepatocellular pattern.2. Assess the severity of elevation of enzymes; In your case it is of a slight level. An image study as an abdominal ultrasound is elementary when it comes to an obstructive process because it speaks of homeostasis; you mention that you have presented isolated episodes of jaundice, however in your image study you did not present any obstructive alteration or biliary tract, considering the high diagnostic yield of abdominal ultrasound in these diagnoses. You should be given laboratory tests such as:1. Viral panel in search of HAD, HBV and HCV infection.2. Search for autoimmune pathologies such as autoimmune hepatitis.3. Inherited or genetic causes where an iron panel is important in the presence of suspected hemochromatosis or ceruloplasmin in case of Wilson's disease. Laboratory studies should be repeated, with special attention to the levels of TGP, TO, albumin, proteins, globulin, alkaline phosphatase. If a suspected diagnosis is presented, it should be studied in a targeted manner. If it is not enough, a liver biopsy should be performed, which may be useful both to find the etiological diagnosis and to evaluate the degree of liver damage.