Question:
A 42-year-old patient presents with obstructive jaundice. Alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and haptoglobin are all increased. The most likely cause is:
A 42-year-old patient presents with obstructive jaundice. Alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and haptoglobin are all increased. The most likely cause is:
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GGT is the enzyme most strongly induced by one of these exposures.
Updated On: Jun 23, 2026
- Alcohol
- Lead
- Chronic renal failure
- None of the above
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The Correct Option is A
Solution and Explanation
Step 1: Read the enzyme pattern. A rise in both ALP and GGT together points to a cholestatic or hepatobiliary process. GGT in particular is a sensitive marker of hepatic injury and is classically induced by alcohol.
Step 2: Link to alcohol. A GGT more than twice normal, especially with an AST to ALT ratio of 2:1 or higher, strongly suggests alcohol related liver injury. GGT is an acute phase reactant that alcohol enzymatically induces.
Step 3: The other clue. Haptoglobin is also an acute phase protein and can rise with hepatic and systemic stress, fitting the alcohol picture in this question.
Step 4: Exclude the rest. Lead toxicity causes anemia and neuropathy, not this cholestatic enzyme pattern, and chronic renal failure does not give obstructive jaundice with raised GGT. So alcohol is the best answer. Ref: Harrison's Principles of Internal Medicine, 20e.
Step 2: Link to alcohol. A GGT more than twice normal, especially with an AST to ALT ratio of 2:1 or higher, strongly suggests alcohol related liver injury. GGT is an acute phase reactant that alcohol enzymatically induces.
Step 3: The other clue. Haptoglobin is also an acute phase protein and can rise with hepatic and systemic stress, fitting the alcohol picture in this question.
Step 4: Exclude the rest. Lead toxicity causes anemia and neuropathy, not this cholestatic enzyme pattern, and chronic renal failure does not give obstructive jaundice with raised GGT. So alcohol is the best answer. Ref: Harrison's Principles of Internal Medicine, 20e.
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