Differential Diagnosis for Elevated Liver Function Tests (LFTs)

Given the patient's LFT results, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Alcoholic Liver Disease: The elevated GGT (127) and ALT (38) with a relatively preserved albumin level (49) and a slight increase in bilirubin (7) could suggest alcoholic liver disease, especially if the patient has a history of alcohol consumption. The GGT level is particularly suggestive of alcohol use.

• Other Likely Diagnoses

  • Non-Alcoholic Fatty Liver Disease (NAFLD): Given the mild elevation in ALT and the presence of slightly elevated bilirubin, NAFLD could be a consideration, especially if the patient has risk factors such as obesity, diabetes, or metabolic syndrome.
  • Viral Hepatitis: Although the ALT is only mildly elevated, viral hepatitis (e.g., hepatitis B or C) could still be a possibility and should be tested for, especially if there are risk factors or symptoms suggestive of hepatitis.
  • Drug-Induced Liver Injury: The patient's medication history should be reviewed, as many drugs can cause elevations in LFTs, including the pattern seen here.

• Do Not Miss Diagnoses

  • Wilson's Disease: Although rare, Wilson's disease can present with elevated LFTs, including a low albumin level and elevated bilirubin. It's crucial to consider this diagnosis due to its potential for severe liver damage and the availability of treatment.
  • Hemochromatosis: This genetic disorder leads to iron overload and can cause liver damage. Early diagnosis is critical to prevent long-term complications.
  • Autoimmune Hepatitis: This condition can present with a wide range of LFT abnormalities and is important to diagnose early due to its responsiveness to immunosuppressive therapy.

• Rare Diagnoses

  • Alpha-1 Antitrypsin Deficiency: A genetic disorder that can lead to liver disease and should be considered in patients with unexplained liver disease, especially if they have a family history of the condition.
  • Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, which can lead to liver dysfunction. It's more likely to be considered if there are signs of liver congestion or thrombophilia.
  • Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver that primarily affects the bile ducts, leading to cholestasis. It's less likely given the pattern of LFTs but should be considered if there are suggestive symptoms or other diagnostic findings.