Step I Liver Pathology question

[canary90]

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Can someone please explain that when there is an elevated serum ALP and a marginally elevated ALT and contrast enhanced CT scan of abdomen shows multiple lesions
Is it liver metastasis or cholangiocarcinoma? And why? Why not the other one?

 

[PowerDan]

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[canary90]

The answer was indeed Liver metastasis and that's how it looks looking at the CT scan; however since the question stem states ALP>> ALT, I picked cholangiocarcinoma, which was a wrong choice.
I fail to understand if its liver metastasis why does the stem say ALP>>ALT which is more of a sign of obstructive lesion...

 

[PowerDan]

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[PowerDan]

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[canary90]

Raised ALP is an indicator of any sort of duct damage, not just obstruction; so it could be raised in either of these conditions. Also, ALP is a pretty non-specific marker.

The CT on the other hand supports a diagnosis of metastasis, so its the best answer, imo.

That makes sense... True, CT goes with metastasis. I shouldn't overthink 😀
Thanks! 🙂

 

[Transposony]

Please mention QBank name in title.

 

[PowerDan]

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[PowerDan]

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