Differential Diagnosis
The patient's laboratory results show a total protein of 9.4, albumin of 4.3, mildly elevated AST, and no gallstones (NGUS). Based on these findings, the following differential diagnoses can be considered:
- Single most likely diagnosis
- Chronic liver disease (e.g., cirrhosis, fatty liver disease): The mildly elevated AST and normal albumin levels suggest a chronic liver condition. The total protein is within the normal range, which further supports this diagnosis.
- Other Likely diagnoses
- NASH (Non-Alcoholic Steatohepatitis): This condition is characterized by inflammation and fat accumulation in the liver, which could explain the elevated AST.
- Alcoholic liver disease: Although the patient's history is not provided, alcoholic liver disease is a common cause of elevated liver enzymes.
- Hepatitis: Viral or autoimmune hepatitis could cause elevated liver enzymes, although the patient's albumin levels are within the normal range.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Liver cancer: Although rare, liver cancer can cause elevated liver enzymes and should be considered, especially if the patient has a history of liver disease or risk factors.
- Budd-Chiari syndrome: This rare condition, caused by hepatic vein thrombosis, can lead to elevated liver enzymes and should be considered in patients with a history of thrombophilia or other risk factors.
- Wilson's disease: This genetic disorder can cause liver damage and elevated liver enzymes, although it is relatively rare.
- Rare diagnoses
- Alpha-1 antitrypsin deficiency: This genetic disorder can cause liver disease and elevated liver enzymes, although it is relatively rare.
- Glycogen storage diseases: These rare genetic disorders can cause liver damage and elevated liver enzymes.
- Autoimmune hepatitis with normal immunoglobulins: Although rare, some patients with autoimmune hepatitis may have normal immunoglobulin levels, making this diagnosis more challenging to identify.