Differential Diagnosis for Nausea, Vomiting, Diarrhea, and Elevated Transaminases

Single Most Likely Diagnosis

• Viral Hepatitis: This is a common cause of elevated transaminases, and symptoms like nausea, vomiting, and diarrhea can occur, especially in the prodromal phase of the illness. The absence of abdominal pain does not rule out viral hepatitis, as not all patients present with pain.

Other Likely Diagnoses

• Food Poisoning: Certain types of food poisoning (e.g., from bacteria like Staphylococcus aureus or viruses) can cause nausea, vomiting, diarrhea, and elevated liver enzymes due to the body's response to the toxin.
• Medication-Induced Liver Injury: Various medications can cause liver injury, leading to elevated transaminases. Nausea, vomiting, and diarrhea can be side effects of the medication or signs of the liver injury.
• Alcoholic Hepatitis: Although abdominal pain is common, it's not universal. Nausea, vomiting, and diarrhea can occur, and elevated transaminases are typical, especially with a history of alcohol abuse.

Do Not Miss Diagnoses

• Acetaminophen Overdose: This is a medical emergency that can present with nausea, vomiting, and diarrhea, and it's a common cause of elevated transaminases. Early recognition is crucial for effective treatment.
• Budd-Chiari Syndrome: Although less common, this condition (hepatic vein thrombosis) can cause liver dysfunction and elevated transaminases. Nausea and vomiting can be symptoms, and diarrhea is less common but possible.
• Wilson's Disease: An inherited disorder that leads to copper accumulation in the liver, causing liver damage. It can present with gastrointestinal symptoms and elevated liver enzymes, and it's crucial to diagnose early to prevent further liver damage.

Rare Diagnoses

• Autoimmune Hepatitis: A chronic disease where the body's immune system attacks the liver, causing inflammation and elevated liver enzymes. Gastrointestinal symptoms can occur, but it's less common as a presenting feature.
• Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver that can cause elevated transaminases. Early in the disease, patients might experience nonspecific symptoms like nausea and fatigue, with diarrhea being less common.
• Hepatic Artery Thrombosis: A rare condition that can cause liver dysfunction and elevated transaminases, especially in patients with risk factors like hypercoagulable states or previous liver transplantation.