Differential Diagnosis for Previous Alcoholic with Elevated Albumin and A/G Ratio but Normal LFTs

• Single Most Likely Diagnosis
  • Alcoholic liver disease in recovery phase: This is likely because the patient has a history of alcoholism, and the elevated albumin and A/G ratio can indicate a recovery phase where the liver is regenerating and producing more albumin, despite previous damage.
• Other Likely Diagnoses
  • NASH (Non-Alcoholic Steatohepatitis): Although the patient has a history of alcoholism, NASH could be a consideration, especially if the patient has other risk factors such as obesity or diabetes. Normal LFTs do not rule out NASH.
  • Chronic viral hepatitis: Some patients with chronic viral hepatitis can have normal LFTs and still have significant liver disease. The elevated A/G ratio could be seen in chronic hepatitis due to increased albumin production.
• Do Not Miss Diagnoses
  • Hepatocellular carcinoma: Although less likely, hepatocellular carcinoma can present with normal LFTs and an elevated A/G ratio. Given the patient's history of alcoholism, which is a risk factor for hepatocellular carcinoma, this diagnosis should not be missed.
  • Alpha-1 antitrypsin deficiency: This genetic disorder can cause liver disease and has a varied presentation, including normal LFTs in some cases. It's crucial not to miss this diagnosis due to its genetic implications and potential for lung disease.
• Rare Diagnoses
  • Autoimmune hepatitis: This condition can present with a wide range of liver function test abnormalities, including normal LFTs. The elevated A/G ratio might be seen in some cases, especially during remission or early stages.
  • Wilson's disease: A genetic disorder leading to copper accumulation in the liver. It can present with normal LFTs and should be considered, especially in younger patients, due to its potential for significant liver damage if untreated.