Differential Diagnosis for Deranged LFT Enzymes with Multiple Bleeding Sites
Single Most Likely Diagnosis
- Viral Hepatitis: This is a common cause of deranged liver function tests (LFTs) and can lead to coagulopathy due to decreased production of clotting factors by the liver, resulting in multiple bleeding sites.
Other Likely Diagnoses
- Alcoholic Liver Disease: Chronic alcohol abuse can lead to liver dysfunction, including deranged LFTs, and can also cause coagulopathy, leading to bleeding complications.
- Liver Cirrhosis: Cirrhosis from any cause can result in deranged LFTs and coagulopathy due to the liver's decreased ability to produce clotting factors.
- Disseminated Intravascular Coagulation (DIC): Although DIC primarily affects the coagulation system, it can also lead to liver dysfunction, making it a consideration in patients with deranged LFTs and multiple bleeding sites.
Do Not Miss Diagnoses
- Vitamin K Deficiency: This is crucial to diagnose because it is easily treatable and can cause significant coagulopathy, leading to bleeding. Liver disease can lead to malabsorption of vitamin K.
- Wilson's Disease: An inherited disorder that leads to copper accumulation in the liver, causing liver dysfunction and potentially coagulopathy. It's rare but critical to diagnose due to its specific treatment and potential for severe liver damage.
- Budd-Chiari Syndrome: A condition caused by thrombosis of the hepatic veins, leading to liver dysfunction and potentially severe coagulopathy. It's rare but can be fatal if not recognized and treated promptly.
Rare Diagnoses
- Autoimmune Hepatitis: Although not the most common cause of liver disease, it can present with deranged LFTs and, in severe cases, coagulopathy.
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and potentially lead to coagulopathy, though it's less common than other liver diseases.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare condition of the immune system that can cause liver dysfunction and coagulopathy among other systemic symptoms.