Pattern of alkaline phosphatase elevation with gamma-glutamyltransferase elevation is most consistent with intrahepatic cholestasis. Which choice reflects this pattern?

Pattern of alkaline phosphatase elevation with gamma-glutamyltransferase elevation is most consistent with intrahepatic cholestasis. Which choice reflects this pattern?

• A. ALP normal and GGT normal
• B. ALP markedly elevated with GGT markedly elevated
• C. ALT markedly elevated
• D. CK elevated

Answer: (B)

Pattern recognition here hinges on distinguishing liver/biliary sources from bone or muscle sources. Alkaline phosphatase comes from both bone and bile ducts, but gamma-glutamyltransferase is a liver/biliary enzyme and is not elevated with bone disease. In intrahepatic cholestasis, bile flow within the liver is impaired, causing a coordinated rise in enzymes produced by the biliary epithelium. So a pattern where alkaline phosphatase is markedly elevated together with a marked rise in gamma-glutamyltransferase strongly points to a hepatobiliary source, i.e., intrahepatic cholestasis. If alkaline phosphatase were high but gamma-GT remained normal, that would suggest a bone origin; an isolated ALT rise would indicate hepatocellular injury rather than cholestasis; CK elevation points to muscle. Thus the combination of high ALP and high GGT best fits intrahepatic cholestasis.

Pattern recognition here hinges on distinguishing liver/biliary sources from bone or muscle sources. Alkaline phosphatase comes from both bone and bile ducts, but gamma-glutamyltransferase is a liver/biliary enzyme and is not elevated with bone disease. In intrahepatic cholestasis, bile flow within the liver is impaired, causing a coordinated rise in enzymes produced by the biliary epithelium. So a pattern where alkaline phosphatase is markedly elevated together with a marked rise in gamma-glutamyltransferase strongly points to a hepatobiliary source, i.e., intrahepatic cholestasis. If alkaline phosphatase were high but gamma-GT remained normal, that would suggest a bone origin; an isolated ALT rise would indicate hepatocellular injury rather than cholestasis; CK elevation points to muscle. Thus the combination of high ALP and high GGT best fits intrahepatic cholestasis.