Alcoholic Cirrhosis and Elevated Liver Enzymes: Your Dx?

the dramatic elevation of aminotransferases may be the result of medication toxicity, acute viral hepatitis, or ischemic injury to the liver. Your assessment?

A 68-year-old man with alcoholic cirrhosis presents with worsening confusion. Lab test results are notable for an AST of 3600 U/L and an ALT 4200 U/L. His alkaline phosphatase level is within normal limits and his total bilirubin is 3.1 mg/dL. His INR is 1.4.

Which of the following is the most likely cause of his presentation?

a. Cholangiocarcinoma
b. Acute hepatitis A
c. Alcoholic hepatitis
d. Acetaminophen toxicity

 Please click here for the answer and discussion.