All of the following are features of Obstructive jaundice except: September 2007

Ans. A: Normal alkaline phosphatase Obstruction to the flow of bile in common bile duct may result from choledocholithiasis, malignancy od head of pancreas, bile ducts or ampulla of Vater. Charcot's triad of intermittent fever, pain and jaundice is characteristic of ascending cholangitis and indicates biliary obstruction. Hepatomegaly is present in most cases of obstructive jaundice and is due to congestion and stretching out of intrahepatic biliary spaces. A palpable gall bladder usually indicates obstruction of the distal CBD, due to other causes like underlying malignancy, than stone (Courvoisier's law). Hepatic bile flow suppression leads to jaundice accompanied by dark urine (bilirubinuria) and light coloured (alcoholic) stools. Bile salts and pigments in urine and absent urobilinogen also our the diagnosis of obstructive jaundice. Serum albumin and prothrombin time are good indicators of liver function derangement. Serum bilirubin levels indicate severity of jaundice and high direct bilirubin rules out hemolytic jaundice. Mild elevation of SGPT levels are also seen in obstructive jaundice consistent with liver dysfunction. An elevated alkaline phosphatase is, always present in obstructive jaundice.