When screening adolescents with obesity, under what circumstances should liver enzymes be considered?

• A. Only when there are clinical features suggesting liver involvement.
• B. Always required for all patients.
• C. Never required.
• D. Only in adults.

Answer: (A)

In adolescents with obesity, liver involvement such as fatty liver disease can occur, but you don’t screen everyone with liver enzymes by default. The idea is to use enzymes as a targeted test guided by clinical clues rather than as a routine check for every patient. If there are signs that the liver might be affected—such as hepatomegaly on exam, right upper quadrant discomfort, jaundice, or other indications of liver dysfunction—then checking liver enzymes helps confirm suspicion and guide further workup. Without these features, routine enzyme testing often adds cost and can lead to unnecessary follow-up. It’s also not something you’d apply only in adults, since the concern and testing approach here are about adolescents. So the best approach is to consider liver enzymes when there are clinical features suggesting liver involvement.