<prompt> A young pt presents with jaundice. Total bilirubin is 21, direct is 9.6, alkphosis 84 KA units. Diagnosis is:Hemolytic jaundiceViral hepatitisChronic active hepatitisObstructive jaundice  <response>: Answer is D Obstructive jaundice: Direct bilirubinemia conjugated birirubin 15 of total bilirubin along with high serum alkaline phosphatase 6-7 times normal suggests the diagnosis of obstructive jaundice. AffirghnfeAre Total bilirubin mgdi 0.3 to 1.0 21.0 Direct bilirubin is 45 of total bilirubin Conjugated bilirubin mgd1 0.1 to 0.3 9.6 Direct bilirubinemia Alkaline phosphatase 3-13 KAV 84 KA Alkaline phosphatase is raised by atleast six times:Significant rise Rise in conjugated bilirubin level may be seen Wth both, hepatocellular disease Viral infective Hepatitis and Obstructive jaundice hut association with significantly elevated ALP limits our diagnosis to obstructive damage. Rise in alkaline phosphatase levels Patient with parenchymal disease of liver i.e. hepatocellular disorders : may show increase in alkaline phosphatase levels but the increase is only slight to moderate and usually not more than two times normal Obstructive lesion: Striking increase in alkaline phosphatase is more suggestive of an obstructive lesion In the given question rise in alkaline phosphatase is about 6 to 7 times normal and thus is more in our of an obstructive cause. 