Differential Diagnosis for R sided abdo pain, orange coloured urine, elevated liver enzymes, and bilirubin
Single most likely diagnosis
- Hepatitis: The combination of right-sided abdominal pain, orange-colored urine (suggestive of bilirubinuria), elevated ALT (alanine transaminase), and bilirubin levels points towards hepatitis as the most likely diagnosis. The elevated ALT suggests liver cell injury, which is consistent with hepatitis.
Other Likely diagnoses
- Cholestasis: The elevated ALP (alkaline phosphatase) and bilirubin levels could indicate cholestasis, which is the reduction or stoppage of bile flow. This could be due to intrahepatic or extrahepatic causes.
- Gallstones: Right-sided abdominal pain and elevated liver enzymes could be indicative of gallstones, especially if they are obstructing the bile ducts, leading to elevated bilirubin and ALP.
- Liver congestion: This could be due to right heart failure, leading to liver congestion, which might cause abdominal pain and elevated liver enzymes.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Acute liver failure: Although the liver enzymes are elevated, the possibility of acute liver failure should not be missed, as it is a life-threatening condition requiring immediate attention.
- Sepsis: Sepsis can cause liver dysfunction and should be considered, especially if there are signs of infection or systemic inflammation.
- Budd-Chiari syndrome: This is a rare condition caused by thrombosis of the hepatic veins, leading to liver dysfunction and could present with abdominal pain and elevated liver enzymes.
Rare diagnoses
- Weil's disease (Leptospirosis): This is a rare bacterial infection that can cause liver and kidney dysfunction, presenting with abdominal pain, jaundice, and elevated liver enzymes.
- Autoimmune hepatitis: Although less common, autoimmune hepatitis could present with elevated liver enzymes and should be considered in the differential diagnosis, especially if other causes are ruled out.
- Wilson's disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver dysfunction and present with abdominal pain and elevated liver enzymes.