Differential Diagnosis for RUQ Pain and Isolated ALT Elevation in a Patient with History of Cholelithiasis
- Single Most Likely Diagnosis
- Cholecystitis: This condition is a strong candidate given the patient's history of cholelithiasis and presentation with right upper quadrant (RUQ) pain. Isolated ALT elevation can occur due to the obstruction of the common bile duct by a gallstone, leading to liver enzyme elevation.
- Other Likely Diagnoses
- Choledocholithiasis: The presence of a gallstone in the common bile duct can cause obstruction, leading to RUQ pain and elevated liver enzymes, including ALT.
- Biliary Dyskinesia: A motility disorder of the gallbladder that can cause biliary colic-like symptoms and potentially affect liver enzyme levels.
- Hepatobiliary Overlap Syndrome: Conditions like primary biliary cholangitis or primary sclerosing cholangitis can present with cholestatic liver enzyme elevation but may initially show isolated ALT elevation.
- Do Not Miss Diagnoses
- Acute Cholangitis: An infection of the biliary tract, usually due to obstruction, which can be life-threatening if not promptly treated. While it often presents with jaundice, fever, and abdominal pain (Charcot's triad), early stages might not have all these symptoms.
- Gallbladder Perforation: A complication of cholecystitis that requires immediate surgical intervention to prevent severe consequences.
- Mirizzi Syndrome: A rare condition where a gallstone becomes impacted in the cystic duct, causing obstruction of the common bile duct and potentially leading to severe liver enzyme elevation and jaundice.
- Rare Diagnoses
- Acalculous Cholecystitis: Inflammation of the gallbladder without the presence of gallstones, more common in critically ill patients but can occur in anyone.
- Bile Duct Stricture: A narrowing of the bile ducts that can cause obstructive jaundice and elevated liver enzymes.
- Gallbladder Cancer: Although rare, it can present with symptoms similar to cholecystitis and should be considered in the differential diagnosis, especially in older patients with a history of gallstones.