A patient presents to the emergency room with malaise. The physician notices slight jaundice. Serum chemistries reveal marked elevation of both aspaate aminotransferase (AST) and alanine aminotransferase (ALT), with the AST/ALT ratio being 2.5. Alkaline phosphatase is near normal. Serum copper and serum iron are normal. Liver damage from which of the following diseases most likely accounts for these findings?
Elevated AST and ALT with a AST/ALT ratio of greater than 1.5 is strongly suggestive of alcoholic hepatitis. Microscopic features of this condition include swollen and necrotic hepatocytes, neutrophil infiltration, Mallory (hyaline) bodies, fatty change, and fibrosis around the central vein. Biliary cirrhosis would be associated with elevated alkaline phosphatase. Hemochromatosis would be associated with elevated serum iron levels. In viral hepatitis, both AST and ALT are elevated, but the ratio is usually less than 1.5. Ref: Jarnagin W.R. (2010). Chapter 24. Liver & Poal Venous System. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
Alcoholic hepatitis
Biliary cirrhosis
Hemochromatosis
Hepatitis A