Differential Diagnosis
- Single most likely diagnosis
- Hemochromatosis: This condition can lead to anemia due to iron overload, transaminitis from liver damage, elevated CK from muscle damage, and potentially a dilated common bile duct due to pancreatic damage or other complications. The normal alkaline phosphatase (all phos) levels do not strongly argue against this diagnosis, as liver enzyme elevations can be variable.
- Other Likely diagnoses
- Chronic pancreatitis: This condition can cause a dilated common bile duct, transaminitis, and potentially anemia due to malabsorption. Elevated CK could be seen if there is associated muscle damage or inflammation.
- Autoimmune hepatitis: This condition can cause transaminitis and anemia. While less directly linked to a dilated common bile duct, autoimmune conditions can have varied presentations, and CK elevation could occur with associated muscle inflammation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pancreatic cancer: Although less likely given the combination of findings, pancreatic cancer can cause a dilated common bile duct and potentially lead to anemia and transaminitis. It's crucial to consider this diagnosis due to its high mortality rate if left untreated.
- Wilson's disease: This rare genetic disorder leads to copper accumulation in the body, causing liver damage (transaminitis), potentially anemia, and neurological symptoms. It could also lead to a dilated common bile duct in advanced cases. Missing this diagnosis could be fatal due to the potential for severe liver damage and other complications.
- Rare diagnoses
- Glycogen storage diseases: Certain types of glycogen storage diseases can lead to elevated CK, anemia, and liver enzyme abnormalities. While rare, these conditions could potentially explain the combination of findings, especially in a younger patient.
- Porphyrias: Some porphyrias can cause abdominal pain, neurological symptoms, and potentially elevated liver enzymes and CK. They are rare but could be considered in the differential diagnosis, especially if other symptoms such as neurological manifestations are present.