In a child presenting with obstructive jaundice all are seen except
**Core Concept**
Obstructive jaundice in children is characterized by elevated levels of certain enzymes and bilirubin due to bile duct obstruction. This condition often results from congenital anomalies or infections affecting the biliary system.
**Why the Correct Answer is Right**
Glutamate dehydrogenase (GDH) is an enzyme primarily associated with the liver's mitochondrial function, particularly in the conversion of glutamate to Ξ±-ketoglutarate. It is not typically elevated in cases of obstructive jaundice. In contrast, alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), and 5' nucleotidase are all enzymes that can be elevated in obstructive jaundice due to their association with the biliary system and bone. Alkaline phosphatase is a nonspecific marker of biliary obstruction, while GGT is more specific to the biliary system. 5' nucleotidase is also elevated in biliary obstruction, especially when alkaline phosphatase levels are low.
**Why Each Wrong Option is Incorrect**
**Option A:** Gamma glutamyl transpeptidase (GGT) is indeed elevated in obstructive jaundice, making it a useful marker for diagnosing biliary obstruction.
**Option B:** Alkaline phosphatase is commonly elevated in obstructive jaundice, serving as a nonspecific marker for biliary obstruction.
**Option D:** 5' Nucleotidase is also elevated in obstructive jaundice and is used as a marker of biliary obstruction, especially when alkaline phosphatase levels are low.
**Clinical Pearl / High-Yield Fact**
When diagnosing obstructive jaundice, it's essential to consider the levels of alkaline phosphatase and GGT in conjunction with other clinical findings, as these enzymes can help differentiate between biliary obstruction and other conditions.
β Correct Answer: C. Glutamate dehydrogenase.