Differential Diagnosis for Elevated Bilirubin and Liver Enzymes with Possible Thumbprint Sign on Bowel
- Single Most Likely Diagnosis
- Mesenteric Ischemia: This condition is characterized by insufficient blood flow to the intestines, which can lead to bowel ischemia or infarction. The "thumbprint sign" on a CT scan is indicative of bowel wall thickening due to ischemia. Elevated liver enzymes and bilirubin can occur due to liver hypoperfusion or secondary to bowel ischemia. The absence of gallbladder obstruction makes this a more likely diagnosis.
- Other Likely Diagnoses
- Hepatitis: Various forms of hepatitis (viral, autoimmune, drug-induced) can cause elevated liver enzymes and bilirubin. While hepatitis might not directly explain the thumbprint sign, it's a common cause of liver dysfunction and should be considered.
- Cholestasis: Conditions causing cholestasis, such as primary biliary cirrhosis or primary sclerosing cholangitis, can lead to elevated bilirubin and liver enzymes. However, these conditions typically have a more chronic presentation and might not directly correlate with the acute finding of a thumbprint sign on the bowel.
- Do Not Miss Diagnoses
- Bowel Infarction: A severe form of mesenteric ischemia leading to bowel infarction, which is a surgical emergency. Missing this diagnosis could be fatal.
- Acute Intestinal Obstruction: Although the question mentions no gallbladder obstruction, other causes of intestinal obstruction (e.g., adhesions, hernias, tumors) could lead to similar findings and require urgent intervention.
- Rare Diagnoses
- Vasculitis (e.g., Polyarteritis Nodosa): Systemic vasculitis can affect the hepatic and mesenteric arteries, leading to ischemia and the observed laboratory and imaging findings. However, this is a less common condition.
- Intra-abdominal Lymphoma: Certain types of lymphoma can cause bowel wall thickening and liver enzyme elevation, though this would be an uncommon presentation and typically associated with other systemic symptoms or findings.