Differential Diagnosis for Elevated ALT and Alkaline Phosphatase
Single Most Likely Diagnosis
- Non-alcoholic fatty liver disease (NAFLD): This condition is a common cause of elevated liver enzymes, particularly ALT, in the absence of significant alcohol consumption. The elevation of alkaline phosphatase can also be seen in NAFLD, especially if there is associated liver fibrosis or bile duct injury.
Other Likely Diagnoses
- Alcoholic liver disease: Similar to NAFLD, alcoholic liver disease can cause elevations in both ALT and alkaline phosphatase due to liver inflammation and potential bile duct damage.
- Viral hepatitis: Hepatitis B and C can cause chronic liver inflammation, leading to elevated liver enzymes, including ALT and alkaline phosphatase.
- Drug-induced liver injury: Certain medications can cause liver damage, resulting in elevated liver enzymes. The pattern of enzyme elevation can vary depending on the drug.
- Primary biliary cholangitis: An autoimmune disease that causes progressive destruction of the bile ducts, leading to elevated alkaline phosphatase and potentially ALT if there is significant liver inflammation.
Do Not Miss Diagnoses
- Wilson's disease: A genetic disorder that leads to copper accumulation in the liver, causing liver damage and potentially life-threatening complications if not treated. It can present with elevated liver enzymes, including ALT and alkaline phosphatase.
- Alpha-1 antitrypsin deficiency: A genetic disorder that can cause liver disease and lung disease. Liver involvement can lead to elevated liver enzymes.
- Budd-Chiari syndrome: A condition caused by thrombosis of the hepatic veins, leading to liver congestion and potentially elevated liver enzymes, including ALT and alkaline phosphatase.
Rare Diagnoses
- Autoimmune hepatitis: A condition where the body's immune system attacks liver cells, causing inflammation and potentially elevated liver enzymes.
- Primary sclerosing cholangitis: A disease that causes scarring and narrowing of the bile ducts, leading to elevated alkaline phosphatase and potentially ALT.
- Hemochromatosis: A genetic disorder that leads to iron accumulation in the body, causing liver damage and potentially elevated liver enzymes.
- Cystic fibrosis: A genetic disorder that can affect multiple organs, including the liver, leading to liver disease and potentially elevated liver enzymes.