In a patient with obstructive jaundice, which pattern of liver function tests is MOST characteristic?

• A Elevated ALT and AST with normal ALP and GGT
• B Elevated ALP, GGT, and conjugated bilirubin with mildly elevated transaminases ✓
• C Elevated unconjugated bilirubin with normal ALP
• D Elevated AST:ALT ratio >2 with elevated ALP

Explanation

Obstructive jaundice is characterized by elevated alkaline phosphatase (ALP) — predominantly the hepatic isoenzyme — and GGT due to cholestasis-induced synthesis, with elevated conjugated bilirubin. Transaminases rise mildly due to hepatocyte pressure necrosis. Option A suggests hepatocellular damage; option C suggests hemolytic jaundice; option D (AST:ALT >2) is characteristic of alcoholic hepatitis.

Reference: Harper's Illustrated Biochemistry, 32nd ed.

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