Differential Diagnosis
The patient's laboratory results show low albumin (3.2 g/dL), elevated AST (92 U/L) and ALT (102 U/L), and a low A/G ratio (0.80). These findings suggest liver dysfunction. Here's a differential diagnosis based on the provided categories:
Single Most Likely Diagnosis
- Cirrhosis: The low albumin level and elevated liver enzymes (AST and ALT) are consistent with cirrhosis, a condition characterized by liver scarring. The low A/G ratio also supports this diagnosis, as it indicates a decrease in albumin production, which is a common finding in cirrhosis.
Other Likely Diagnoses
- Alcoholic Liver Disease: The pattern of liver enzyme elevation (AST > ALT) and low albumin level could be seen in alcoholic liver disease. The patient's history of alcohol use would support this diagnosis.
- Non-Alcoholic Fatty Liver Disease (NAFLD): Although NAFLD typically presents with a milder elevation of liver enzymes, the low albumin level and elevated GGT could suggest advanced disease, such as non-alcoholic steatohepatitis (NASH).
- Chronic Viral Hepatitis: Chronic infection with hepatitis B or C viruses can lead to liver dysfunction, characterized by elevated liver enzymes and low albumin levels.
Do Not Miss Diagnoses
- Budd-Chiari Syndrome: This rare condition, characterized by hepatic vein thrombosis, can present with liver dysfunction, ascites, and abdominal pain. Although unlikely, it is a potentially life-threatening condition that should not be missed.
- Wilson's Disease: This genetic disorder leads to copper accumulation in the liver, causing liver dysfunction. Although rare, it is essential to consider in young patients with unexplained liver disease.
- Autoimmune Hepatitis: This condition can present with elevated liver enzymes, low albumin levels, and a low A/G ratio. It is essential to consider autoimmune hepatitis, as it requires prompt treatment to prevent liver failure.
Rare Diagnoses
- Alpha-1 Antitrypsin Deficiency: This genetic disorder can lead to liver disease, characterized by low albumin levels and elevated liver enzymes.
- Glycogen Storage Diseases: Certain glycogen storage diseases, such as type I glycogen storage disease, can present with liver dysfunction, including low albumin levels and elevated liver enzymes.
- Cystic Fibrosis: Although primarily a pulmonary disease, cystic fibrosis can also affect the liver, leading to liver dysfunction and low albumin levels.