Gamma-glutamyl transferase (GGT) is elevated in a patient. Which combination would MOST specifically indicate alcohol-related liver disease?
- A Elevated GGT alone
- B Elevated GGT + elevated ALP + elevated bilirubin
- C Elevated GGT + AST:ALT ratio >2:1 + mean corpuscular volume >100 fL ✓
- D Elevated GGT + elevated direct bilirubin
Correct answer: C. Elevated GGT + AST:ALT ratio >2:1 + mean corpuscular volume >100 fL
Explanation
The triad of GGT elevation, AST:ALT ratio >2:1, and macrocytosis (MCV >100 fL from acetaldehyde-mediated folate interference and direct marrow toxicity) is characteristic of alcoholic liver disease. GGT alone is a sensitive but non-specific marker induced by multiple drugs and in cholestasis. AST:ALT >2:1 occurs because alcohol depletes pyridoxal phosphate, which is preferentially needed for ALT synthesis.
Reference: Harper's Illustrated Biochemistry, 32nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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