Differential Diagnosis for Raised GGT, ALT, AST in a Non-Alcoholic Male, 62 Years
Single Most Likely Diagnosis
- Non-Alcoholic Fatty Liver Disease (NAFLD): This is the most likely diagnosis given the patient's age and the pattern of liver enzyme elevation. NAFLD is a common condition in older adults and can lead to elevated liver enzymes, particularly GGT, ALT, and AST, in the absence of significant alcohol consumption.
Other Likely Diagnoses
- Drug-Induced Liver Injury: Various medications can cause liver enzyme elevations. Given the patient's age, it's possible that he is on multiple medications, increasing the risk of drug-induced liver injury.
- Viral Hepatitis: Although less common in older adults, viral hepatitis (e.g., hepatitis B or C) can still occur and cause liver enzyme elevations.
- Ischemic Hepatitis: This condition, also known as "shock liver," can occur in older adults with cardiovascular disease and can lead to significant elevations in liver enzymes.
Do Not Miss Diagnoses
- Hepatocellular Carcinoma: Although less likely, hepatocellular carcinoma can present with elevated liver enzymes. Given the potential for severe outcomes, it's crucial not to miss this diagnosis.
- Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can lead to liver enzyme elevations and has a high mortality rate if not promptly diagnosed and treated.
- Wilson's Disease: Although rare, Wilson's disease can present at any age and can cause significant liver enzyme elevations. It's essential to consider this diagnosis to avoid missing a potentially treatable condition.
Rare Diagnoses
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and enzyme elevations. It's rare but should be considered in patients with unexplained liver enzyme elevations.
- Hemochromatosis: A genetic disorder leading to iron overload, which can cause liver enzyme elevations. It's less common but should be considered, especially if other signs of iron overload are present.
- Autoimmune Hepatitis: An autoimmune condition that can cause liver inflammation and enzyme elevations. It's rare but can be treated with immunosuppressive therapy, making it an important diagnosis to consider.