Differential Diagnosis: Elevated ALT

Following are differential diagnoses for patients presented with elevated ALT.

• Hepatocyte damage

  • Hypoxia (eg, anemia, cardiopulmonary disease, thromboembolic disease, seizures, ischemic myopathy [cats])

  • Portosystemic shunt

  • Portal vein hypoplasia 

  • Hepatic lipidosis (cats)

  • Diabetes mellitus

  • Hyperthyroidism

  • Hyperadrenocorticism (usually only mild to moderate elevation, less common than ALP elevation) 

  • Neoplasia

  • Inflammatory (eg, copper storage disease, chronic hepatitis)

  • Infectious (eg, leptospirosis, bacterial cholangiohepatitis, FIP, histoplasmosis, canine infectious hepatitis [adenovirus type 1])

  • Drugs (eg, acetaminophen, azathioprine, carprofen, tetracyclines, methimazole, trimethoprim–sulfonamides, amiodarone, chronic phenobarbital administration) 

  • Toxicity (eg, blue-green algae, Amanita spp mushrooms, aflatoxin, xylitol, sago palm, azole antifungals) 

  • Reactive hepatopathy (eg, enteritis, chronic enteropathy) 

  • Pancreatitis

  • Trauma 

  • Muscular dystrophy (dogs) 

• Induction (independent from toxicity) 

  • Phenobarbital 

  • Glucocorticoids

• Other

  • Liver lobe torsion