American Board of Internal Medicine (ABIM) Certification Practice Exam

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What can elevated alkaline phosphatase levels suggest in patients' liver function tests?

  1. Gallbladder disease

  2. Cholestasis or hepatic conditions

  3. Pancreatitis

  4. Cardiovascular disease

The correct answer is: Cholestasis or hepatic conditions

Elevated alkaline phosphatase (ALP) levels are predominantly associated with cholestasis and hepatic conditions. Alkaline phosphatase is an enzyme that is found in various tissues, with high concentrations in the liver, bile ducts, and bone. When there is an obstruction of bile flow—whether due to a gallstone, a tumor, or other hepatic conditions—alkaline phosphatase levels can rise significantly. This increase serves as an important laboratory marker for cholestatic liver diseases, which include conditions like primary biliary cholangitis and primary sclerosing cholangitis. While gallbladder disease can also contribute to elevated ALP levels, it is primarily the cholestatic process that is specifically indicated by significantly increased levels in liver function tests. Conditions affecting bone metabolism or disease could also elevate ALP but would not be associated with liver function in this context. Pancreatitis primarily influences amylase and lipase levels rather than alkaline phosphatase, and cardiovascular disease does not typically result in elevated alkaline phosphatase in liver function tests. Thus, option B accurately reflects the pathological conditions indicated by elevated alkaline phosphatase levels in the context of liver function testing.