Differential Diagnosis for Multiple Gallstones and High ALP

• Single most likely diagnosis
  • Cholelithiasis with cholestasis: This is the most likely diagnosis given the presence of multiple gallstones, which can cause obstruction of the bile ducts leading to cholestasis, characterized by elevated alkaline phosphatase (ALP) levels.
• Other Likely diagnoses
  • Primary Biliary Cholangitis (PBC): An autoimmune disease that leads to progressive destruction of the bile ducts, resulting in cholestasis and elevated ALP levels. Gallstones can be a secondary complication.
  • Primary Sclerosing Cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts, which can lead to cholestasis, elevated ALP, and an increased risk of gallstones.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pancreatic Cancer: Although less common, pancreatic cancer can cause obstruction of the bile ducts, leading to cholestasis and elevated ALP levels. The presence of gallstones might be incidental, but the possibility of pancreatic cancer should not be overlooked due to its high mortality rate.
  • Cholangiocarcinoma: A cancer of the bile duct, which can present with cholestasis, elevated ALP, and gallstones. Early diagnosis is crucial for treatment.
• Rare diagnoses
  • Caroli's Disease: A rare congenital disorder characterized by non-obstructive dilatation of the intrahepatic bile ducts, which can lead to recurrent cholangitis, stone formation, and elevated ALP levels.
  • Alagille Syndrome: A genetic disorder that affects the liver, heart, and other parts of the body, characterized by a reduction in the number of bile ducts within the liver, leading to cholestasis and elevated ALP levels. Gallstones can be a complication.