Great explanation on ALP from /u/taz92vagconqueror on reddit:
ALP is related to bone + biliary tract obstruction + leukemias. Although the liver does make ALP, for the USMLE just know that ALP is usually mentioned for the above three scenarios. Bile duct obstruction releases ALP as a result of cell damage. In bone/leukemias, it's because of increased cell turnover. To differentiate bone vs biliary we test for Gamma-GT (and for leukemias just differentiate it from the others by the clinical scenario).
This patient likely has Gilbert syndrome (FA2020 p394).
This is because his hyperbilirubinemia occurs during periods of stress and is relatively benign. Gilbert's syndrome has elevated unconjugated bilirubin because there is a mild deficiency in UDP-glucuronyltransferase conjugation. Thus, the cause is decreased conjugation of bilirubin.
submitted by โhungrybox(1277)
(wrong answer explanation)
Intermittent obstruction of the common bile duct is wrong.
Biliary tract obstruction would have:
โโ direct (conjugated) bilirubin (normal 0.0-0.3, pt was 0.4)
โ Alkaline phosphatase (normal = 20-70, pt was 35)