Differential Diagnosis
- Single most likely diagnosis
- B) Alcoholic hepatitis: The patient has a history of alcohol use disorder, and the laboratory results show significantly elevated AST and ALT levels, with a ratio of AST:ALT > 2:1, which is characteristic of alcoholic hepatitis. The patient's symptoms, including confusion, nausea, abdominal pain, and conjunctival icterus, also support this diagnosis.
- Other Likely diagnoses
- A) Acetaminophen toxicity: Although the patient's friend reported that the patient wanted to "drink all my troubles away," which suggests alcohol consumption, acetaminophen toxicity is a possible cause of liver injury, especially given the elevated liver enzymes. However, the AST:ALT ratio and the patient's history of alcohol use disorder make alcoholic hepatitis more likely.
- E) Impacted gallstone: The patient's abdominal tenderness over the right upper quadrant and elevated lipase level could suggest a gallstone-related issue. However, the liver enzyme elevations and conjunctival icterus are more suggestive of a liver-related condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cirrhosis with variceal hemorrhage: Although cirrhosis is a possible underlying condition, the patient's presentation does not strongly suggest variceal hemorrhage. However, this condition can be life-threatening and should be considered.
- Sepsis: The patient's elevated leukocyte count and hypotension could suggest sepsis, which is a life-threatening condition that requires prompt recognition and treatment.
- Rare diagnoses
- D) Hepatocellular cancer: While hepatocellular cancer is a possible cause of liver dysfunction, it is less likely given the patient's acute presentation and lack of other suggestive findings, such as a liver mass on imaging.
- Other rare liver conditions, such as autoimmune hepatitis, Wilson's disease, or Budd-Chiari syndrome, are also possible but less likely given the patient's history and presentation.