In a patient with obstructive jaundice, which pattern of liver enzyme elevation is most characteristic?

• A Markedly elevated AST and ALT with mildly elevated ALP and GGT
• B Elevated indirect bilirubin with normal ALP and GGT
• C Elevated LDH with normal transaminases and ALP
• D Markedly elevated ALP and GGT with mildly elevated AST and ALT ✓

Explanation

Obstructive jaundice (cholestatic pattern) is characterised by disproportionate elevation of ALP and GGT, which are synthesised in bile duct epithelium and reflux into blood when biliary pressure rises. Transaminases (AST/ALT) are only mildly elevated. Elevated indirect bilirubin points to hemolysis. The AST/ALT predominance pattern is seen in hepatocellular injury.

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

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