Differential Diagnosis for Fatty Liver with Low Albumin, Mildly Elevated AST and ALT, and Alkaline Phosphatase

• Single Most Likely Diagnosis
  • Fatty Liver Disease (Steatosis): This condition is characterized by the accumulation of fat in liver cells, which can lead to elevated liver enzymes (AST and ALT) and is often associated with low albumin levels due to impaired liver function. The mildly elevated alkaline phosphatase can also be seen in fatty liver disease, especially if there is associated cholestasis.
• Other Likely Diagnoses
  • Non-Alcoholic Steatohepatitis (NASH): A more aggressive form of fatty liver disease, NASH can cause inflammation and damage to liver cells, leading to higher elevations in liver enzymes and potentially more significant reductions in albumin levels.
  • Alcoholic Liver Disease: Similar to fatty liver disease but caused by alcohol consumption, this condition can lead to a range of liver abnormalities, including elevated liver enzymes, low albumin, and changes in alkaline phosphatase levels.
  • Chronic Viral Hepatitis: Conditions like hepatitis B and C can cause chronic liver inflammation, leading to elevated liver enzymes, low albumin levels, and potentially elevated alkaline phosphatase, especially in advanced disease.
• Do Not Miss Diagnoses
  • Cirrhosis: A late stage of liver disease characterized by scarring of the liver, cirrhosis can lead to significant elevations in alkaline phosphatase, low albumin levels due to decreased liver synthetic function, and mildly elevated transaminases.
  • Liver Cancer (Hepatocellular Carcinoma): Although less common, liver cancer can present with abnormal liver function tests, including elevated alkaline phosphatase and low albumin, and is a critical diagnosis not to miss due to its poor prognosis if untreated.
  • Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, it can lead to liver dysfunction, including elevated liver enzymes, low albumin, and significantly elevated alkaline phosphatase.
• Rare Diagnoses
  • Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease, it may present with elevated liver enzymes, low albumin, and can lead to liver cirrhosis.
  • Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, it can cause liver dysfunction, including elevated liver enzymes and low albumin levels, and is important to diagnose early to prevent liver damage.
  • Autoimmune Hepatitis: A condition where the body's immune system attacks liver cells, it can lead to elevated liver enzymes, low albumin, and changes in alkaline phosphatase levels, and requires early diagnosis and treatment to prevent liver failure.