A 45-year-old man with a history of chronic alcohol use presents with abdominal pain and jaundice. Laboratory findings show elevated ALT (400 U/L), AST (500 U/L), and GGT (350 U/L), with a normal alkaline phosphatase. What is the most likely diagnosis? A) Acute viral hepatitis B) Alcoholic hepatitis C) Non-alcoholic fatty liver disease (NAFLD) D) Hepatic metastasis E) Cirrhosis Correct Answer: B) Alcoholic hepatitis Explanation: Alcoholic hepatitis is characterized by marked elevation of AST and ALT (typically AST > ALT), elevated GGT, and a history of chronic alcohol consumption. The normal alkaline phosphatase rules out biliary causes. Acute viral hepatitis (A) usually has a more severe elevation of ALT and AST and may have an associated positive viral serology (e.g., hepatitis B or C). Non-alcoholic fatty liver disease (NAFLD) (C) is typically diagnosed in patients with obesity, diabetes, or metabolic syndrome, and it shows a milder elevation in liver enzymes. Hepatic metastasis (D) is more likely to present with unexplained weight loss, elevated alkaline phosphatase, and normal AST/ALT. Cirrhosis (E) is associated with decompensated liver disease and usually has low albumin, elevated bilirubin, and prolonged PT, rather than primarily elevated AST and ALT. Key Tips for PLAB 1: ✅ AST > ALT, history of alcohol use = Alcoholic hepatitis ✅ Consider liver biopsy for confirmation in unclear cases.
