Differential Diagnosis

• Single most likely diagnosis
  • Alcoholic hepatitis: The patient has a history of alcohol use disorder, and the laboratory results show elevated liver enzymes (ALT and AST), bilirubin, and a prolonged prothrombin time (INR=2.5). The patient's symptoms, including confusion, nausea, abdominal pain, and conjunctival icterus, are also consistent with alcoholic hepatitis.
• Other Likely diagnoses
  • Acetaminophen toxicity: Although the patient's friend reported that he wanted to "drink all my troubles away," it is possible that the patient also took acetaminophen, which can cause liver damage. The elevated liver enzymes and bilirubin levels could be consistent with acetaminophen toxicity.
  • Cirrhosis: The patient's history of alcohol use disorder and laboratory results, including elevated liver enzymes and bilirubin, could also be consistent with cirrhosis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Impacted gallstone: Although less likely, an impacted gallstone could cause the patient's abdominal pain and elevated liver enzymes. If missed, it could lead to severe complications, including cholangitis and sepsis.
  • Hepatocellular cancer: Although rare, hepatocellular cancer could be a possible diagnosis, especially given the patient's history of alcohol use disorder and elevated liver enzymes.
• Rare diagnoses
  • Other causes of liver disease: Other rare causes of liver disease, such as autoimmune hepatitis, Wilson's disease, or alpha-1 antitrypsin deficiency, could also be considered, although they are less likely given the patient's presentation and history.
  • Infections: Infections, such as viral hepatitis or bacterial infections, could also be considered, although they are less likely given the patient's presentation and laboratory results.