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What does my abdominal ultrasound scan report indicate?

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2380 Questions

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Posted on Mon, 13 Nov 2017 in Digestion and Bowels
Question: I'm male and 48 years old. I had blood work for a physical last week and everything was perfect except for a moderately elevated Alkaline Phosphatase at 214. All other liver enzymes, blood work, and urine were perfectly normal. I have no symptoms of anything. No pain, jaundice, stomach issues, nothing.

Doc sent me for an Abdominal Ultrasound. Turns out I have a 2.2 cm floating gallstone and a "diffuse fatty infiltration of the liver" which my doctor said was not of concern. All other aspects of the ultrasound were normal and negative. Pancrease, Bile Ducts, Liver (except for the fatty part), Kidneys, were all fine and negative for any problems. There was no inflammation of the gall bladder or ducts. PSA was normal. Fecal Occult was negative.

I've read many opinions about if removal of the gall bladder is necessary at this point and most opinions I read are to keep an eye on it because I have no symptoms. My doctor, while wonderful, I think is not well versed in this area of medicine and he is perplexed about the elevated ALP. I've been told by two other physicians that the elevated ALP is likely explained by the gallstone.

My questions. Is the elevated ALP likely from the gallstone? I realize it could be bone as well, but I don't think I have any bone issues. All things seems to lead back to the stone. Could the ALP be pancrease, kidney, etc related, especially with no symptoms, negative Ultrasound, and all other blood work fine? My doctor just seems confused.

What is your opinion on gall bladder surgery in my situation?

Thank you!
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Go for laproscopic removal of gallbladder.

Detailed Answer:
Hello,
Thanks choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

See before comming to your question i eould like to give you a small briefing about your problem.
Mild to moderate elevation of a liver function in a otherwise normal patient has no clinical significance.
Clinically to be significant at least three times the maximum upper normal level of elevation of enzyme should be there in a patient.

Only if If other liver tests such as bilirubin, aspartate aminotransferase (AST), or alanine aminotransferase (ALT) are also high, then we consider that the increased ALP is coming from the liver.

In your case ALP elevation can be linked to gallbladder stone.
ALP is found in abundance in bile duct.Stone or debris erodes the mucosal lining of gallbladder causing mild to moderate inflammation hence ALP is leaked into blood causing increase in its level.

Gallbladder stones are a very important cause of elevation of ALP.


Now lets move to your questions-

1)Yes it is due to gall stones.
It can be due to a number of causes but we have to go as per the reports.Your reports are suggestive of gall stone so its the cause of elevation of ALP.

2)You should definitely go for a planned endoscopic surgery.
Silent or asymptomatic stones are very dangerous.A small stone can slip into common bile duct and may reach pancreas causing acute emergency condtion like Acute pancreatitis which can even be fatal in some cases.Therefore its advisable to go for a planned endoscopic surgery for gallbladder removal.

Hope i clear your doubts well.
Feel free to follow up.

Thanks!

Above answer was peer-reviewed by : Dr. Vishesh Rohatgi
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
Thank you for your time. Much appreciated. Since this stone is larger at 2.2cm, does it make it more or less likely of getting stuck in a bile duct than a smaller one? I guess what I'm asking is do I need to rush into surgery or can it be scheduled in the next month or so? I know nothing is certain, but since it is asymptomatic, in general, do I have a little time or am I looking at an imminent problem?

My family doctor is a bit confused about the "floating stone" diagnosis and it's relation to and reason for the elevated ALP. Does the floating make a difference? Am I correct in reading about the inflammation part in your answer that the floating stone can hit the sides of the gallbladder and cause the irritation? There was no cholesystitis found on the ultrasound.

The ALP has nothing to do with the pancrease or kidneys, correct? They were both fine on the ultrasound. Not stomach or colon related? Sorry one more. My ALP was 90 on a blood test 15 months ago. Can a stone grow that fast over a year period to cause this elevation?

Again, thank you for your help and I will give you the highest rating.
doctor
Answered by Dr. Ramesh Kumar 3 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
Both the conditions are equally problematic if the stone gets impacted in bile duct it would obstruct the flow of bile leading to stagnation of bile causing a condition termed as Acute cholecystitis.

No its not necessary that you rush into surgery but a planned laproscopic removal in next few months is a better idea.
You can take your time .
Floating means that stone is non impacted in nature and can change its position.Therefore the movements are more hence the amount of mucosa damaged is more leading to increase in ALP.
In case of impacted stones the movements of stone is not there therefore it does not rub against soft mucosal surface.

You can consider an example suppose you leave a rough hard ball inside a plastic tube.First ball is free to move while the second one is impacted.The one free to move would cause more scratch to plastic pipe then the one impacted.

Cholecystitis means severe inflammation.Its not severe in your case but as alp is elevated it means that some amount of scratching is done by moments of stone in duct.

They are all non specific enzymes and therefore it can't be said that they have no relation to pancreas.Our hepatobiliary system functions as a unit it contains liver,pancreas,gallbladder.So if one part of unit is effected directly or indirectly it may have effect on other parts also.

Ultrasound etc are much more sensitive and specific then Liver enzymes panel(that too only one enzyme is deranged in your case).So as better investigations are normal there is no reason to say that this may be related to kidney or pancreas.

alp is just an indicator of problem, while to confirm it we do usg.
As usg is normal your system is fine.

As per the trials done on number of patients it has been seen that patients with gallbladder stones have elevated levels of ALP. However there is no such data that increase in size is related to elevation of this enzyme.
As explained earlier they are all indicators of problem,If they indicate that something is wrong we go for better investigations like USG or CT scan.

Hope i was helpful.
Please feel free to follow up in case you have any other confusion.
Best of luck and have a nice day ahead.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 6 hours later
Thank you. Appreciate your help. This can be done laparoscopy, correct?
doctor
Answered by Dr. Ramesh Kumar 20 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Thank you for appreciation.
Yes laproscopic removal is the latest and almost scarless procedure.
The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly and would use laproscope to remove your bladder.
It would take less then 1 and a half hour for the procedure.Once stable you would be discharged in48-72 hours.

If any other detail is required you can ask in follow up.

Thanks!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 35 hours later
Thank you. One more question and i will close this out. My doc is sending me for a repeat metabolic panel. I was curious as to how much ALP can rise and fall over a course of a couple weeks. Is it like blood sugar, where it can be all
ove the place, depending on time of day and what you ate, or is it fairly steady? Just wondering if one day it could be at 500 and the next at 90? Does it change much?

I was just curious as to why I needed to take a retest? My doc was speaking of lab anomaly, but as said earlier, it seems very obvious that it is the gallstone.

I appreciate all your help. Enjoy your day.
doctor
Answered by Dr. Ramesh Kumar 7 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear patient,
Thanks for the follow up.
ALP or any other liver enzyme takes atleast 1 month for a significant change in otherwise normal patient.
Most likely your doctor is in opinion that test results are in correct therefore he is suggesting you to repeat the test again.
No unless you have any serious pathological condition a particular enzyme can't vary from 500 to 90 in a day.These tupe of variations usually are seen in patients who have an acute or chronic condition.

Most likely your doctor is thinking of a test anomaly.

Thanks and best wishes!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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