Differential Diagnosis for Elevated Liver Enzymes

Elevated liver enzymes that occur overnight can be caused by a variety of conditions. Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Acute Viral Hepatitis: This is a common cause of sudden elevation in liver enzymes. Viruses such as hepatitis A, B, and C can cause inflammation of the liver, leading to elevated liver enzymes. The sudden onset is consistent with an acute viral infection.

• Other Likely Diagnoses

  • Alcoholic Hepatitis: Although this typically presents after a period of heavy alcohol use, it can sometimes cause a rapid increase in liver enzymes.
  • Non-Alcoholic Fatty Liver Disease (NAFLD) with Acute Exacerbation: While NAFLD is a chronic condition, acute exacerbations can lead to sudden increases in liver enzymes.
  • Drug-Induced Liver Injury (DILI): Certain medications and supplements can cause liver injury, leading to elevated liver enzymes. The onset can be rapid if the offending agent was recently introduced.
  • Ischemic Hepatitis (Shock Liver): This condition occurs due to decreased blood flow to the liver and can cause a sudden increase in liver enzymes.

• Do Not Miss Diagnoses

  • Acetaminophen Overdose: This is a medical emergency that can cause rapid elevation of liver enzymes due to liver necrosis. Early recognition and treatment are crucial.
  • Budd-Chiari Syndrome: This rare condition involves thrombosis of the hepatic veins, which can lead to sudden liver dysfunction and elevated liver enzymes.
  • Wilson's Disease with Acute Presentation: Although rare, Wilson's disease can cause acute liver failure with rapid elevation of liver enzymes, especially in young individuals.

• Rare Diagnoses

  • Autoimmune Hepatitis: While more commonly presenting with a gradual onset, autoimmune hepatitis can occasionally cause a rapid increase in liver enzymes.
  • Primary Biliary Cholangitis (PBC): Typically a chronic condition, but rare cases can present acutely.
  • Hemophagocytic Lymphohistiocytosis (HLH): A rare and potentially life-threatening condition that can cause elevated liver enzymes among other systemic symptoms.
  • Vascular Malformations or Thrombosis: Rare vascular issues affecting the liver can lead to sudden elevations in liver enzymes.