Differential Diagnosis for Raised ALP, GGT, ALT, and AST
Single Most Likely Diagnosis
- Alcoholic Liver Disease: This condition is a common cause of elevated liver enzymes, including ALP, GGT, ALT, and AST. The elevation of GGT, in particular, is often associated with alcohol consumption. Alcoholic liver disease can range from steatosis to cirrhosis, and the pattern of enzyme elevation can vary depending on the stage and severity of the disease.
Other Likely Diagnoses
- Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD can cause elevations in ALT, AST, and sometimes ALP and GGT, especially in the context of non-alcoholic steatohepatitis (NASH). The disease is closely linked to metabolic syndrome, obesity, and insulin resistance.
- Viral Hepatitis: Acute or chronic viral hepatitis (e.g., hepatitis B or C) can lead to elevations in ALT, AST, and sometimes ALP and GGT. The pattern of enzyme elevation can help differentiate between acute and chronic infection.
- Drug-Induced Liver Injury: Various medications and drugs can cause liver injury, leading to elevations in liver enzymes. The pattern of enzyme elevation can vary depending on the offending agent.
Do Not Miss Diagnoses
- Wilson's Disease: Although rare, Wilson's disease is a genetic disorder that leads to copper accumulation in the liver, causing liver damage and enzyme elevations. It is crucial to diagnose early to prevent irreversible liver damage and neurological complications.
- Autoimmune Hepatitis: This condition can present with elevated liver enzymes, including ALP, GGT, ALT, and AST. It requires prompt recognition and treatment to prevent liver failure.
- Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can lead to liver enzyme elevations and requires urgent diagnosis and treatment to prevent liver failure.
Rare Diagnoses
- Primary Biliary Cholangitis (PBC): A chronic liver disease characterized by progressive destruction of the bile ducts within the liver, leading to cholestasis and elevations in ALP and GGT.
- Primary Sclerosing Cholangitis (PSC): A rare disease that causes scarring and narrowing of the bile ducts, leading to elevations in ALP and GGT.
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and enzyme elevations, particularly in children and young adults.