A liver biopsy shows significant hepatocellular necrosis. Among the serum enzyme markers, which pattern BEST distinguishes hepatocellular injury from pure cholestasis?
- A Elevation of GGT with normal ALT
- B Disproportionate rise in ALT over ALP, with ALT:ALP ratio > 5 ✓
- C Elevated conjugated bilirubin with normal transaminases
- D Isolated rise in indirect (unconjugated) bilirubin
Correct answer: B. Disproportionate rise in ALT over ALP, with ALT:ALP ratio > 5
Explanation
An ALT:ALP ratio (expressed as multiples of upper limit of normal) greater than 5 characterises hepatocellular injury, while a ratio less than 2 favours cholestatic disease; values 2–5 are mixed. Pure cholestasis elevates ALP and GGT with minimal transaminase rise. Elevated conjugated bilirubin with normal transaminases may represent isolated transport defects such as Dubin-Johnson syndrome, not hepatocellular necrosis.
Reference: Harper's Illustrated Biochemistry, 32nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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