A 35-year-old woman is evaluated for jaundice in an emergency depament. For several days, the patient has had mild flu-like symptoms of anorexia, nausea and vomiting, fatigue, low-grade fever, and malaise. This morning, she noted that her urine was brown in color, and she has also developed moderate, steady, pain of the right upper quadrant of her abdomen. She has not had any similar episodes in the past. On physical examination, the patient is noted to be jaundiced and to have an enlarged, tender liver. Blood chemistry studies are notable for alanine aminotransferase (ALT) of 15,000 mIU/L, aspaate aminotransferase (AST) of 11,000 mIU/L, and alkaline phosphatase of 100 U/L. Which of the following is the most likely diagnosis?
This person's markedly elevated AST and ALT with modest elevation of alkaline phosphatase strongly suggests that she has acute hepatitis. The clinical presentation with flu-like symptoms that progress to jaundice is also typical. Chronic hepatitis and cirrhosis would present more insidiously and would not have the extremely high elevations of AST and ALT. Gallstone disease can cause acute abdominal pain, and occasionally jaundice (if a small stone occludes the common bile duct), but would not usually cause the very high elevations of AST and ALT seen in this patient.
Acute hepatitis
Chronic hepatitis
Gallstone disease
Hepatic cirrhosis