Differential Diagnosis for 71-year-old Female with Elevated Liver Enzymes
Single Most Likely Diagnosis
- Chronic Hepatitis C or Non-Alcoholic Fatty Liver Disease (NAFLD): The patient's age and mildly elevated liver enzymes (AST 42, ALT 60) suggest a chronic liver condition. The slightly elevated bilirubin (1.8) may indicate some degree of liver dysfunction. Both Hepatitis C and NAFLD are common in this age group and can present with similar laboratory findings.
Other Likely Diagnoses
- Alcoholic Liver Disease: Although not explicitly stated, the patient's age and laboratory results could be consistent with alcoholic liver disease, especially if she has a history of alcohol consumption.
- Drug-Induced Liver Injury: Many medications can cause liver enzyme elevations, and given the patient's age, she may be taking multiple medications that could contribute to this condition.
- Viral Hepatitis (Acute or Chronic): Other forms of viral hepatitis, such as Hepatitis B, could also explain the patient's laboratory results, although they might be less common than Hepatitis C in this demographic.
Do Not Miss Diagnoses
- Hemochromatosis: A genetic disorder leading to iron overload, which can cause liver enzyme elevations and potentially severe liver damage if not diagnosed and treated.
- Wilson's Disease: An inherited disorder that causes copper accumulation in the liver, leading to liver damage. Although rare, it's critical to diagnose due to the availability of effective treatment.
- Budd-Chiari Syndrome: A condition characterized by hepatic vein thrombosis, which can present with liver enzyme elevations and is potentially life-threatening if not promptly diagnosed and treated.
- Liver Metastases: In a 71-year-old patient, the possibility of metastatic disease to the liver from another primary cancer site should be considered, as it would significantly alter management and prognosis.
Rare Diagnoses
- Autoimmune Hepatitis: An autoimmune condition causing liver inflammation, which can present with elevated liver enzymes. It's less common but important to consider due to its responsiveness to immunosuppressive therapy.
- Primary Biliary Cholangitis (PBC): A chronic liver disease characterized by progressive destruction of the bile ducts within the liver, leading to liver enzyme elevations. It's more common in women and can present at any age.
- Primary Sclerosing Cholangitis (PSC): A disease that leads to scarring and narrowing of the bile ducts, causing liver enzyme elevations. It's rare and often associated with inflammatory bowel disease.