Differential Diagnosis for 32yo Female with Epigastric Pain and Elevated AST/ALT
- Single Most Likely Diagnosis
- Viral Hepatitis: The patient's presentation of epigastric pain and significantly elevated AST and ALT levels without a history of alcohol or NSAID use suggests a liver pathology. Viral hepatitis (e.g., hepatitis A, B, or C) is a common cause of such liver enzyme elevations and could explain the epigastric pain due to liver inflammation.
- Other Likely Diagnoses
- Autoimmune Hepatitis: This condition can cause elevated liver enzymes and may present with nonspecific symptoms such as epigastric pain. It is an important consideration in a young female without a clear cause for liver enzyme elevation.
- Wilson's Disease: Although rare, Wilson's disease can cause liver enzyme elevations and may present at a young age. It is a genetic disorder leading to copper accumulation in the liver.
- Non-alcoholic Fatty Liver Disease (NAFLD): Given the absence of alcohol use, NAFLD could be a consideration, especially if the patient has risk factors such as obesity, diabetes, or metabolic syndrome.
- Do Not Miss Diagnoses
- Acute Hepatic Porphyrias: These are a group of rare genetic disorders that can cause severe abdominal pain and elevated liver enzymes. They are critical to diagnose because they can lead to neurological complications if not treated promptly.
- Budd-Chiari Syndrome: This condition, caused by hepatic vein thrombosis, can present with abdominal pain and elevated liver enzymes. It is a medical emergency due to the risk of liver failure.
- Fulminant Liver Failure: Although the patient's current presentation does not suggest fulminant failure, any condition causing significant liver enzyme elevation warrants consideration of this potentially deadly diagnosis.
- Rare Diagnoses
- Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and elevated liver enzymes. It is rare but should be considered in young patients with unexplained liver disease.
- Hemochromatosis: A genetic disorder leading to iron overload, which can cause liver enzyme elevations. It is less common in young females but should be considered in the differential diagnosis of liver disease.