Differential Diagnosis for 8-year-old Female with Elevated Liver Enzymes
Single Most Likely Diagnosis
- Viral Hepatitis: This is a common cause of elevated liver enzymes in children, with hepatitis A, B, and C being potential culprits. The significant elevation in ALT (200) compared to AST (119) suggests a hepatocellular injury pattern, which is consistent with viral hepatitis.
Other Likely Diagnoses
- Autoimmune Hepatitis: This condition can present with elevated liver enzymes and is more common in females. The presence of other autoimmune diseases or a family history could support this diagnosis.
- Wilson's Disease: Although rare, Wilson's disease is an important consideration in children with elevated liver enzymes, as it can lead to cirrhosis and liver failure if not treated promptly. It typically presents with a low alkaline phosphatase level relative to the degree of transaminase elevation, but this can vary.
- Non-Alcoholic Fatty Liver Disease (NAFLD): NAFLD is increasingly recognized in children and can cause elevated liver enzymes. Risk factors include obesity, insulin resistance, and a family history of NAFLD.
Do Not Miss Diagnoses
- Acetaminophen Toxicity: Although the history might not always be forthcoming, acetaminophen overdose is a critical diagnosis to consider due to its potential for severe liver injury and the availability of antidotal therapy (N-acetylcysteine).
- Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can present with acute liver dysfunction and is a medical emergency requiring prompt intervention.
- Ischemic Hepatitis (Shock Liver): This condition occurs due to decreased hepatic blood flow and can be seen in the context of shock, severe dehydration, or heart failure.
Rare Diagnoses
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and elevated liver enzymes in children. It's rare but important to consider, especially if there's a family history.
- Glycogen Storage Diseases: Certain types of glycogen storage diseases, like type IV, can cause liver dysfunction and elevated enzymes.
- Mitochondrial Disorders: Some mitochondrial disorders can affect the liver and cause elevated liver enzymes, although this is less common in presentation.