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Wilson ALF Diagnostic Ratio — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyWilson ALF Diagnostic RatioRACP Adult Medicine

A 50-year-old man with known Wilson disease develops acute liver failure with Coombs-negative haemolytic anaemia. Bilirubin:ALP ratio >2.0, ALP <600 U/L. What does this ratio suggest?

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Correct answer: BWilson disease – disproportionately low ALP with high bilirubin

Bilirubin:ALP ratio >2.0 with low ALP is characteristic of Wilsonian ALF. Low ALP reflects zinc-mediated ALP inhibition.

Reference: eTG – 2025; EASL – 2012 – Wilson Disease