Differential Diagnosis for Periportal Edema and Elevated LFTs

Single Most Likely Diagnosis

• Viral Hepatitis: This is a common cause of elevated liver function tests (LFTs) and can lead to periportal edema due to inflammation of the liver. The most likely viral hepatitis causing this presentation would be hepatitis A, B, or C, given their prevalence and the fact that they can cause significant liver inflammation.

Other Likely Diagnoses

• Alcoholic Hepatitis: Chronic alcohol abuse can lead to liver inflammation and damage, resulting in elevated LFTs. Periportal edema can occur due to the liver's response to injury.
• Non-Alcoholic Fatty Liver Disease (NAFLD): This condition, often associated with obesity and metabolic syndrome, can progress to non-alcoholic steatohepatitis (NASH), leading to liver inflammation, elevated LFTs, and potentially periportal edema.
• Autoimmune Hepatitis: An autoimmune condition where the body's immune system attacks liver cells, leading to inflammation, elevated LFTs, and potentially periportal edema.
• Drug-Induced Liver Injury (DILI): Certain medications can cause liver injury, leading to elevated LFTs and periportal edema. The likelihood depends on the medication and the individual's susceptibility.

Do Not Miss Diagnoses

• Budd-Chiari Syndrome: A condition caused by thrombosis of the hepatic veins, leading to liver congestion, periportal edema, and elevated LFTs. It is crucial to diagnose promptly as it can be life-threatening if not treated.
• Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, causing liver damage, elevated LFTs, and potentially periportal edema. Early diagnosis is critical to prevent irreversible liver damage.
• Acute Liver Failure: A condition characterized by the rapid loss of liver function, which can be caused by various factors including viral infections, drug toxicity, and ischemia. It is a medical emergency.

Rare Diagnoses

• Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver characterized by a progressive destruction of the bile ducts within the liver, leading to cholestasis, elevated LFTs, and potentially periportal edema.
• Primary Sclerosing Cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts, leading to cholestasis, elevated LFTs, and potentially periportal edema.
• Veno-occlusive Disease (VOD): A condition characterized by the obstruction of small hepatic venules, leading to liver congestion, periportal edema, and elevated LFTs. It is often associated with bone marrow transplantation or the use of certain drugs.