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nbme24/Block 3/Question#6

A 43-year-old woman comes to the physician because ...

Alkaline phosphatase

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 +5  upvote downvote
submitted by lm4(6),

in the exocrine pancreas, gallbladder, and liver pathology section of pathoma, sattar mentions that the epithelium lining biliary tract has alkaline phosphatase so when they are damaged it releases this, increasing serum alk phos.


 +1  upvote downvote
submitted by yotsubato(207),

ALT and AST are enzymes within hepatocytes. Without hepatocyte damage, you wont have elevations.

Alkaline phosphatase is present in all tissues throughout the entire body, but is particularly concentrated in the liver, bile duct, kidney, bone, intestinal mucosa and placenta.


 +1  upvote downvote
submitted by m-ice(116),

This patient has a gallstone lodged in the common bile duct. Therefore, the markers most likely to be elevated is something from the biliary tract, the best of which is alkaline phosphatase. There could potentially be elevations in AST and ALT, but this is not the MOST likely answer. Unconjugated bilirubin is not a good answer, because the liver can still conjugate all bilirubin, it just has issues now excreting that conjugated form. So the woman's CONJUGATED bilirubin is more likely to be elevated.