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Etiology

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  • Acute viral hepatitis (ALT > AST)

  • Toxic hepatitis, eg, acetaminophen

  • Alcoholic hepatitis (AST < ALT)

  • Cirrhosis (AST > ALT)

  • Vascular: right-sided congestive heart failure, shock liver, Budd-Chiari syndrome

  • Biliary tract obstruction (followed by increased alkaline phosphatase and bilirubin)

  • Nonalcoholic fatty liver disease (formerly NASH)

  • Metabolic, eg, hemochromatosis, Wilson’s disease

  • Liver abscess

  • Hepatocellular or metastatic cancer

  • Drugs, eg, INH, statins

  • Heart or skeletal muscle injury

  • Celiac sprue (ALT)

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AST/ALT > 500-1000

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  • Acetaminophen, Amanita mushroom, other toxins

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  • Viral, especially hepatitis A

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  • Shock liver (ischemia)

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  • Budd-Chiari syndrome

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  • Right-sided heart failure

See related DDx

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