Differential Diagnosis for Patient with Elevated Liver Enzymes and Gallbladder Stone

Single Most Likely Diagnosis

• Cholelithiasis with Chronic Cholecystitis: The presence of a single stone in the gallbladder, elevated liver enzymes (AST, ALT, GGTP), and a thin gallbladder wall on ultrasound are highly suggestive of chronic cholecystitis due to gallstones. The thin gallbladder wall can be a sign of chronic inflammation.

Other Likely Diagnoses

• Acute Cholecystitis: Although the bile ducts are not distended, and the gallbladder wall is described as thin (which might not align with the typical thickening seen in acute cholecystitis), acute inflammation cannot be ruled out without clinical correlation (e.g., presence of pain, fever).
• Choledocholithiasis: The presence of a stone in the gallbladder and elevated liver enzymes could suggest a stone in the common bile duct, even though the bile ducts are not distended. This condition can cause intermittent obstruction and might not always present with dilated bile ducts on imaging.

Do Not Miss Diagnoses

• Malignancy (Gallbladder Cancer or Cholangiocarcinoma): Although less common, malignancies involving the gallbladder or bile ducts can present with similar findings, including stones, elevated liver enzymes, and changes in the gallbladder wall. These conditions are critical to identify early due to their poor prognosis if left untreated.
• Primary Sclerosing Cholangitis (PSC): This chronic liver disease can cause inflammation and scarring in the bile ducts, leading to elevated liver enzymes and potentially gallstones. It's a less common condition but important to consider due to its implications for liver health and potential progression to cirrhosis or cholangiocarcinoma.

Rare Diagnoses

• Mirizzi Syndrome: A rare condition where a gallstone becomes impacted in the cystic duct or the neck of the gallbladder, causing obstruction of the common bile duct. This could potentially explain the elevated liver enzymes and the presence of a single stone, although it's less likely given the absence of bile duct dilation.
• Gallbladder Dysplasia or Adenoma: These are precancerous conditions of the gallbladder that could potentially cause changes in liver enzymes and the appearance of the gallbladder on ultrasound, although they are much less common than other diagnoses listed here.