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Diagnosed with ulcerative colitis. ALP is 625. What could be the cause for elevation in liver function test?

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Gastroenterologist
Practicing since : 1996
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Happy Saturday

I had posted on 10/13 that my 23 year old daughter who has been diagnosed with ulcerative colitis in mid July 2013, had a reading of 626 ALP in the liver function test. What could cause this elevation? should we repeat labs? Our local doctor here is requesting a liver biopsy? Is there a less invasive procedure? Are there other lab tests which can be done?

one of the doctor's through Health Care Magic responded this way:
However, this elevation of alkaline phosphatase merits evaluation. There can be many potential reasons for this, some not worrisome but others are of concern.

So it is important to get to the bottom of this.

For example, it could be from vitamin D deficiency, liver conditions or bone problems to name a few. There is a systematic way to approach this through thorough clinical assessment (ie history and physical examination by a doctor) along with lab tests like
CBC
CMP (which includes liver function tests)
GGT
5' nucleotidase
25 hydroxy vitamin D levels
Phosphorus
Intact PTH
Posted Fri, 15 Nov 2013 in Digestion and Bowels
 
 
Answered by Dr. Ratnakar Kini 45 minutes later
Brief Answer:
Primary sclerosing cholangitis should be ruled out

Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.Ratnakar Kini and I am pleased to assist you.

Alkaline phosphatase (ALP) has got many sources like liver/biliary tract, bone etc.
To confirm that it is from liver, other tests like GGT and 5' nucleotidase should be done.
Primary sclerosing cholangitis has to be ruled out if there is elevated ALP in association with ulcerative colitis.

Ulcerative colitis as you know is the disease affecting colon presenting with bloody diarrhea. But it has other associated symptoms also. One such association is primary sclerosing cholangitis. In this condtion, the bile duct is narrowed causing obstruction to the bile flow.
In this condition, the alkaline phosphatase (ALP) level may go up.
This condition can be confirmed with MRCP and p-ANCA tests.

So primary sclerosing cholangitis has to be ruled out as it is a common association with ulcerative colitis.

You can consult a gastroenterologist and discuss about this possibility and get the above mentioned tests done.

Let me know if I can assist you further.
Regards,
Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with ulcerative colitis. ALP is 625. What could be the cause for elevation in liver function test? 7 hours later
Thanks so much for your feedback, Dr. Kini. That is what I have read and have been in denial - the p-ANCA test is what showed the ALP level of 626. The doctor is requesting a biopsy but we have asked for a MRCP. It is beyond scary to think of PSC - she is a complete outlier to the profile of people who get PSC - Indian - tamil origin - we live in Florida - she does not even fit the statistic in anyway shape or form....so Dr. Kini, have you run into Indian women - under 25 - who have been diagnosed with PSC? It is of course possible - but am wondering if there are any other reasons to have these elevated ALP levels. Look forward to your response.
 
 
Answered by Dr. Ratnakar Kini 10 hours later
Brief Answer:
Detailed answer given below

Detailed Answer:
Hi,
Nice to hear that you are of Tamil origin. I am from Chennai.
We should not always go by the statistics.
Clinical correlation should be done.

If a person with ulcerative colitis has persistently elevated ALP, then PSC has to be ruled out. MRCP is a simple non-invasive test that will help to diagnose it.

I would like to add that if it is only transient elevation, then it could be due to other conditions like improper nutrition, infection or a fatty liver. So you need to check her liver enzymes after controlling her UC symptoms. If the ALP remains elevated even after the control of UC symptoms, then you can plan MRCP.
I will not go for a liver biopsy before doing all these.

Let me know if I can assist you further.
Regards,
Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with ulcerative colitis. ALP is 625. What could be the cause for elevation in liver function test? 5 hours later
Totally understand - was just wondering about the statistics, that's all. Definitely, we are planning repeat labs and if it sustains, then MRCP. Thank you so much....it has been SO ENCOURAGING to hear from you. I grew up in T Nagar - very nostalgic for me. We have lived in the US for the past 30 years. Going with faith, courage, and strength. I will update you after the clinical evaluation. Thanks again.
 
 
Answered by Dr. Ratnakar Kini 32 minutes later
Welcome.
Do update me after the clinical evaluation

Above answer was peer-reviewed by
 
Follow-up: Diagnosed with ulcerative colitis. ALP is 625. What could be the cause for elevation in liver function test? 22 minutes later
Thanks Dr. Kini - forgot to mention to you that I looked up all different possibilities - obviously it can be utterly confusing to read on the internet - we are also befuddled by the genetics aspect of it.

My daughter was all set to go to medical school and this zinger came out of nowhere - but we are proceeding with care, compassion, faith, and positive thoughts.

It is amazing that with the way health care works, we were able to connect up so randomly with a physician in Chennai - life always works out well at the end.

I assume I should send the update through Healthcare Magic - correct? I am happy to do that but wanted to confirm.
 
 
Answered by Dr. Ratnakar Kini 8 minutes later

Yes you can update me through Healthcare Magic.
Above answer was peer-reviewed by
 
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