Which two enzymes help distinguish bone from liver disease when ALP is increased?

• A. 5-NT and GGT
• B. ALT and AST
• C. CK and LDH
• D. ALP and TP

Answer: (A)

When ALP is elevated, it can come from bone or liver. To tell the source, use enzymes that are specific to the liver. Gamma-glutamyl transferase (GGT) rises with hepatobiliary disease and is not elevated by bone disease. 5'-nucleotidase (5'-NT) behaves similarly, increasing with liver pathology. So, measuring both helps pinpoint the origin: if both GGT and 5'-NT are elevated alongside ALP, the ALP is likely from the liver; if they stay normal, the ALP is more likely from bone. The other enzyme pairs don’t provide this specific distinction as effectively.