Differential Diagnosis
The patient presents with elevated liver enzymes (AST 274, ALT 174, ALP 187) and a history of alcoholism, post-AAA repair, and hypertension. The following differential diagnosis is organized into categories:
- Single Most Likely Diagnosis
- Alcoholic hepatitis: The patient's history of alcoholism, combined with the elevated liver enzymes (particularly the AST:ALT ratio > 2), suggests alcoholic hepatitis as the most likely diagnosis.
- Other Likely Diagnoses
- Ischemic hepatitis: The recent AAA repair and hypertension increase the risk of ischemic hepatitis, which can cause elevated liver enzymes.
- Drug-induced liver injury: The patient may have been exposed to medications during the post-operative period that can cause liver injury.
- Hepatic congestion: The patient's history of hypertension and recent AAA repair may increase the risk of hepatic congestion, which can cause elevated liver enzymes.
- Do Not Miss Diagnoses
- Acute liver failure: Although less likely, acute liver failure can be a life-threatening condition that requires prompt recognition and treatment.
- Budd-Chiari syndrome: This rare condition, caused by hepatic vein thrombosis, can present with elevated liver enzymes and should not be missed due to its high mortality rate.
- Hemorrhagic shock: The patient's recent AAA repair increases the risk of hemorrhagic shock, which can cause ischemic hepatitis and elevated liver enzymes.
- Rare Diagnoses
- Wilson's disease: This rare genetic disorder can cause elevated liver enzymes, but it is less likely given the patient's age and presentation.
- Alpha-1 antitrypsin deficiency: This rare genetic disorder can cause liver disease, but it is less likely given the patient's presentation and lack of other symptoms.
- Veno-occlusive disease: This rare condition, caused by obstruction of the hepatic venules, can present with elevated liver enzymes, but it is less likely given the patient's presentation and lack of other symptoms.