Which laboratory pattern is most typical of hepatocellular injury in hepatitis?

• A. Elevated ALT and AST
• B. Elevated alkaline phosphatase
• C. Elevated amylase
• D. Low bilirubin

Answer: (A)

When liver cells are damaged, their cytosolic enzymes leak into the bloodstream. This makes transaminases the most telling lab pattern of hepatocellular injury, with a rise in ALT being particularly characteristic because ALT is more specific to the liver. In hepatitis, both ALT and AST increase, and ALT often exceeds AST, reflecting active hepatocyte injury.

Alkaline phosphatase tends to rise with cholestasis or biliary obstruction, not primarily from hepatocyte injury. Amylase elevation points to pancreatic involvement, not liver damage. Bilirubin can be elevated in hepatitis due to impaired uptake, conjugation, or excretion, so a pattern of low bilirubin isn’t typical. Therefore, the hallmark pattern in hepatocellular injury is elevated ALT and AST, with ALT being the more liver-specific indicator.