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

### input:
Dear doctor im 39 years 178cm tall 124 kg wieght. i have mild enlarged liver showing bright fatty parenchyma &mild cystitis should be excluded&colonic gases distension&rbcs show mild microcytosis-hypochromia&random blood glucose 178&cholestol 287-triglocerides 171-ldl choles 198&pus 8 -ca oxalate++&amorphous elementes urate++&hematocrit 40.8 thanks doctor

### output:

Hi, Thanks for your question. After going through your question, I can understand your concern. Considering your Height & weight your BMI is more than 39 which denote Level 2 obesity.Also, you fulfill the criteria of Metabolic syn Chat Doctor.  That increases possibility of insulin resistance in you. Insulin resistance increases the chances of -- Diabetes or Pre-Diabetes.- NASH (Non Alcohol State- Hepatitis) which is associated with enlarged fatty liver with increased liver enzymes. Changes of cystitis on ultrasound denote urinary infection which is further supported by presence of pus cells on urine examination. You should do following investigations -- OG TT (Oral Glucose Tolerance Test) & HbA1c.- T3, T4, TSH.- Liver function test.- Renal function test.- Calcium, phosphorus, uric acid.- ECG, 2DEcho. There is a need for Weight reduction in you for which there is a need of - - Calories and fat restricted planned diet after consulting nutrition specialist.- Regular exercise to be started gradually according to your level of effort tolerance.- Bariatric surgery may be considered if above measures failed.Also, there is a need for antibiotic treatment for urinary infection and statin therapy for cholesterol control. You should consult Endocrinologist for better evaluation. Hope this helps you.