Differential Diagnosis for Elevated Bilirubin, AST, and Alkaline Phosphatase

Single Most Likely Diagnosis

• Viral Hepatitis: This is a common cause of elevated liver enzymes and bilirubin. Viral hepatitis (such as hepatitis A, B, or C) can lead to inflammation of the liver, resulting in elevated AST, alkaline phosphatase, and bilirubin levels.

Other Likely Diagnoses

• Alcoholic Liver Disease: Chronic alcohol consumption can lead to liver damage, causing elevations in liver enzymes and bilirubin. The pattern of enzyme elevation can vary but often includes increased AST and alkaline phosphatase.
• Drug-Induced Liver Injury: Various medications can cause liver injury, leading to elevated liver enzymes and bilirubin. The pattern of elevation can depend on the drug but often includes increases in AST, alkaline phosphatase, and bilirubin.
• Cholestasis: Conditions that cause obstruction of the bile ducts, such as gallstones or tumors, can lead to elevated alkaline phosphatase and bilirubin. AST may also be elevated due to associated liver injury.

Do Not Miss Diagnoses

• Acute Biliary Obstruction: This is a medical emergency that requires prompt intervention. Conditions such as gallstones or bile duct tumors can cause obstruction, leading to elevated alkaline phosphatase, bilirubin, and potentially AST.
• Wilson's Disease: A genetic disorder that leads to copper accumulation in the liver, causing liver damage. It can present with elevated liver enzymes and bilirubin and is critical to diagnose early to prevent liver failure.
• Autoimmune Hepatitis: An autoimmune condition that causes the body's immune system to attack the liver, leading to inflammation and elevated liver enzymes and bilirubin. Early diagnosis and treatment are crucial to prevent liver failure.

Rare Diagnoses

• Budd-Chiari Syndrome: A rare condition caused by obstruction of the hepatic veins, leading to liver congestion, damage, and elevation of liver enzymes and bilirubin.
• Primary Biliary Cholangitis (PBC): A chronic liver disease characterized by progressive destruction of the bile ducts within the liver, leading to cholestasis and elevated alkaline phosphatase and bilirubin.
• Primary Sclerosing Cholangitis (PSC): A rare disease that leads to scarring and narrowing of the bile ducts, causing cholestasis and elevated alkaline phosphatase and bilirubin.