Elevated Alkaline Phosphatase

[mbuckley]

My 24 month old daughter, adopted from Guatemala has elevated liver enzymes (about 47 for the past yr and dr. says normal range is 0-40).  

At her two year check, blood also showed elevated alkaline phosphastase levels (first 3700 and then one week later 2600)Dr. says normal range for a growing child is under 300.

The 5-prime nucleutidase test reveals that the liver is responsible for the elevated ASP>   We are going to see a gastrointerologist.

My question is:  Since the liver is the organ responsible for the elevated ASP, does this mean that it is liver disease or could it be due to a less serious ailment?

Thank you

[Kevin Pho, MD]

Chronic cholestatic or infiltrative liver diseases should be considered in patients in whom the alkaline phosphatase is determined to be of liver origin and persists over time. The most common causes include partial bile duct obstruction, primary biliary cirrhosis (PBC), primary sclerosing cholangitis, adult bile ductopenia, and certain drugs such as androgenic steroids and phenytoin. Infiltrative diseases include sarcoidosis, other granulomatous diseases, and less often unsuspected cancer metastatic to the liver.  Obviously, some of these diseases can be eliminated due to the age of your daughter.

An ultrasound would be the next reasonable test to consider.  I would also suggest a referral to a 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.