Elevated Liver Enzymes - Differential Diagnosis Algorithm

Severe ALT > 15x ULN

 • Viral

 • Drugs/Toxins

 • Ischemia

 • Autoimmune

 • Wilson's

 • Pregnancy - AFLP, HELLP

Moderate ALT 5-15x ULN

 • Viral

 • Drugs

 • Wilson's

 • Hemochromatosis

 • NAFLD

 • Others

Mild ALT < 5x ULN

 • NAFLD

 • Alcohol

 • Viral

 • Hemochromatosis

 • Drugs

 • AIH

 • A1AT deficiency

 • Wilson's

 • Others

 • Cholestatic disease

US — Normal Bile Ducts

 • PSC

 • Alcoholic hepatitis

 • Drugs

 • TPN

 • Sepsis

 • Infiltrative

 • Cirrhosis (any)

 • Congenital

US - Dilated Bile Ducts

 • Common Bile Duct Stone

 • Biliary stricture

 • Worms/flukes

 • Cholangiocarcinoma

 • Pancreatic cancer

 • Others



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