Differential Diagnosis for Elevated AST, ALT, and Increased Bleeding Time

Single Most Likely Diagnosis

• Viral Hepatitis: This condition is a common cause of elevated liver enzymes (AST and ALT) and can also lead to coagulopathy, resulting in increased bleeding time due to decreased production of clotting factors by the liver.

Other Likely Diagnoses

• Alcoholic Liver Disease: Chronic alcohol consumption can lead to liver damage, causing elevations in AST and ALT. Additionally, alcohol can impair platelet function and lead to coagulopathy, increasing bleeding time.
• Non-Alcoholic Fatty Liver Disease (NAFLD): Although less commonly associated with coagulopathy than viral hepatitis or alcoholic liver disease, severe cases of NAFLD can lead to liver dysfunction, potentially affecting coagulation and causing increased bleeding time.
• Drug-Induced Liver Injury: Certain medications can cause liver damage, leading to elevated liver enzymes. If the liver injury is severe, it might also affect the liver's ability to produce clotting factors, thereby increasing bleeding time.

Do Not Miss Diagnoses

• Vitamin K Deficiency: This condition can lead to coagulopathy and increased bleeding time due to the deficiency of vitamin K, which is essential for the production of certain clotting factors. Although less likely to cause significant elevations in AST and ALT, it's crucial not to miss due to its potential for severe bleeding complications.
• Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver damage and dysfunction. It might result in elevated liver enzymes and, in severe cases, affect the liver's ability to produce clotting factors, leading to increased bleeding time.

Rare Diagnoses

• Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, leading to liver dysfunction, which can result in elevated liver enzymes and coagulopathy, increasing bleeding time.
• Autoimmune Hepatitis: Although it can cause significant liver enzyme elevations, autoimmune hepatitis is less commonly associated with coagulopathy compared to other liver diseases. However, in severe cases, it could potentially lead to increased bleeding time.
• Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and, in severe cases, lead to liver dysfunction affecting coagulation factor production and increasing bleeding time.