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Differential Diagnosis: Elevated ALT

Marie Chartier, DVM, DACVIM (Internal Medicine), VCA Roberts Animal Hospital, Hanover, Massachusetts

Internal Medicine

|November 2022|Peer Reviewed

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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

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For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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