A 58-year-old male with chronic hepatitis C virus infection presents with painless jaundice, dark urine, and pale stools. Laboratory tests reveal total bilirubin 145 umol/L, direct bilirubin 115 umol/L, alkaline phosphatase (ALP) 580 U/L, and gamma-glutamyl transferase (GGT) 490 U/L, with only mild transaminase elevations (ALT 65 U/L). What pattern of liver injury does this represent?

Answer and explanation

Correct answer: B. Cholestatic pattern of liver injury

  1. Step 1: A disproportionate elevation in alkaline phosphatase (ALP) and GGT relative to ALT/AST, accompanied by direct (conjugated) hyperbilirubinemia, defines a cholestatic pattern of liver injury (biliary obstruction or intrahepatic cholestasis).
  2. Step 2: Consequently, the correct clinical answer is Cholestatic pattern of liver injury.
Answer
Cholestatic pattern of liver injury.
Why not the others: 'Hepatocellular necrosis pattern' features marked elevations in ALT and AST (often in the hundreds or thousands) with relatively lower ALP; 'Isolated pre-hepatic unconjugated hyperbilirubinemia' features elevated indirect bilirubin with normal ALP and ALT (e.g., hemolysis); 'Gilbert syndrome' presents with benign, mild unconjugated hyperbilirubinemia during fasting.

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