Differential Diagnosis
- Single most likely diagnosis
- Alcoholic Hepatitis: The patient's history of increased alcohol consumption, jaundice, and elevated liver enzymes (AST > ALT) are consistent with alcoholic hepatitis. The presence of spider nevi and temporal wasting also suggests chronic liver disease.
- Other Likely diagnoses
- Alcoholic Cirrhosis: The patient's long history of alcohol abuse and physical examination findings (jaundice, spider nevi, temporal wasting) suggest the possibility of cirrhosis. However, the absence of ascites and extremity edema makes this diagnosis less likely.
- Viral Hepatitis: Although the patient's history of alcohol abuse is prominent, viral hepatitis (e.g., hepatitis B or C) could also cause elevated liver enzymes and jaundice. However, the lack of specific risk factors or symptoms makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Acute Biliary Obstruction: Although the ultrasonography is negative for obstruction, it is essential to consider this diagnosis due to the patient's abdominal pain and jaundice. A missed diagnosis could lead to severe consequences, such as cholangitis or pancreatitis.
- Pancreatitis: The patient's abdominal pain and elevated liver enzymes could also be consistent with pancreatitis. Although the patient's history of alcohol abuse is more suggestive of liver disease, pancreatitis is a potentially life-threatening condition that should not be missed.
- Rare diagnoses
- Autoimmune Hepatitis: This diagnosis is less likely given the patient's history of alcohol abuse, but it could be considered if other diagnoses are ruled out. Autoimmune hepatitis can present with elevated liver enzymes and jaundice, but it is relatively rare compared to other liver diseases.
- Wilson's Disease: This rare genetic disorder can cause liver disease and neuropsychiatric symptoms. Although it is unlikely given the patient's age and presentation, it should be considered if other diagnoses are ruled out and the patient has a suggestive family history or physical examination findings (e.g., Kayser-Fleischer rings).