elevated liver enzymes

I just received results of my yearly blood test back.  My Alk. Phosphatase was 167 (s/b no higher than 110), and Bilirubin is at it's boarderline, 1.5.  Cholesterol is 259 (HDL=67, LDL=158).  (Cholesterol has showed high since December - and has decreased about 10 points).  AST (30) and ALT (17) are normal.

My diet is vry healthy - with the exception of occasional chocolate binges.  I don't drink.   I came off HRT a year and a half ago.  My age is 51.  This is the first time I've ever had these problems.  Could I be eating something I shouldn't, or in excess of what I should?  What could be the cause, in your opinion?  (both parents had gall stones)

Thank you

[Kevin Pho, MD]

Serum alkaline phosphatase is derived predominantly from the liver and bones, although other sources may contribute to serum levels in some settings.  If all the liver tests are normal (i.e. normal GGT as well as the normal liver enzymes you have reported), then you may want to inquire about bone diseases (i.e. obtaining a bone scan).

Initial liver testing should include a right upper quadrant ultrasound (which can assess the hepatic anatomy and bile ducts) and an antimitochondrial antibody (AMA), which is highly suggestive of PBC (primary biliary cirrhosis).

A positive AMA test should be followed up with a liver biopsy.  I would discuss this workup with your personal physician or gastroenterologist.

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.  Approach to the patient with abnormal liver function tests.  UptoDate, 2004.