What is going on with my liver

I am a F, 48, 168 lbs (open RNY w gallbladder removal on May 23, 2003).  I have lost 120 pounds in past 5 months.  I don

[Kevin Pho, MD]

There are several possibilities that would be associated with your liver tests.  Note that you have already gone through MRCPs and a cholecystectomy.  Here are some possibilities that can be associated with the elevated alkaline phosphatase:
- Obstructive jaundice due to cancer
- Common duct stones
- Sclerosing cholangitis
- Bile duct stricture
- Drug and toxins associated with cholestasis
- Primary biliary cirrhosis
- Infectious hepatobiliary diseases seen in patients with AIDS (eg, CMV or microsporidiosis and tuberculosis with hepatic involvement).
- Alcohol-induced steatonecrosis (rarely)

Fatigue and itching makes primary biliary cirrhosis something you want to rule out in light of your previous workup.  I would suggest inquiring about a liver biopsy to further evaluate for this and other liver conditions that may also elevate the alkaline phosphatase and the liver function tests.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Pratt, et al.  Alkaline phosphatase and other enzymatic measures of cholestasis.  UptoDate, 2003.

[Kachina48]

I want to add that right now, extreme fatigue and itching are my worst symtoms (symptoms).  Temps appear fairly normal.  I am so tired that I am either sleeping or just sitting in a daze much of the time.  I wake up alot at night with severe itching.  Benedryl helps, but takes a while to work and just seems to increase the fatigue.

[Over_Dairy]

A related discussion, CBD Stricture noted post-laproscopic gallbladder removal was started.