Which lab pattern on a liver panel best indicates cholestasis rather than hepatocellular injury?

Which lab pattern on a liver panel best indicates cholestasis rather than hepatocellular injury?

• A. Elevated ALT only
• B. Elevated ALP and GGT with bilirubin and ductal dilation
• C. Elevated ALT and AST with normal ALP
• D. Normal ALP and GGT

Answer: (B)

Lower biliary flow issues (cholestasis) produce a distinctive lab pattern: alkaline phosphatase and gamma-glutamyl transferase rise because they come from biliary epithelium and reflect bile duct involvement, and bilirubin increases because conjugated bilirubin backs up when bile can't reach the intestine. Ductal dilation on imaging supports an obstructive process. In contrast, hepatocellular injury mainly causes rises in transaminases (ALT and AST) due to hepatocyte damage, while ALP is not prominently elevated. So the combination of high ALP and GGT with bilirubin and ductal dilation points to cholestasis rather than hepatocellular injury.

Lower biliary flow issues (cholestasis) produce a distinctive lab pattern: alkaline phosphatase and gamma-glutamyl transferase rise because they come from biliary epithelium and reflect bile duct involvement, and bilirubin increases because conjugated bilirubin backs up when bile can't reach the intestine. Ductal dilation on imaging supports an obstructive process. In contrast, hepatocellular injury mainly causes rises in transaminases (ALT and AST) due to hepatocyte damage, while ALP is not prominently elevated. So the combination of high ALP and GGT with bilirubin and ductal dilation points to cholestasis rather than hepatocellular injury.