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Gastroenterology (Expert Forum)
Mild ALP and Liver Biopsy
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Mild ALP and Liver Biopsy
by Brian Berg, Mar 18, 2006 12:00AM
In Nov, I had routine LFT's due to feeling tired and had a cold. All tests normal except Alk Phos was 156 (136u/l). Dr. said come back in a month get retested. I felt fine in about a week after that.I went back in 2 months and alk phos was 160, all other tests normal. Since then Ive had ultrasound which found a 3cm hemangioma which was confirmed by a Cat scan.
Isoenzynes, which confirmed alk phos coming from Liver. Primary Care Dr. mentioned PBC. Referred to Gastroenterologist. Had 8 other blood tests, including ana, ama, hep panels...etc...etc. Was told I had a resolved HEP b. or was immunized...also had additional HepC, HEPB rna/dna etc..etc..
Was told other then hemangioma, Ultrasound, mri, catsacn looked good.
I assume that being a male and negative on ama test...pretty much rules out PBC.
Then had a MRCP(also normal)....all test have been normal. Other then asma that was >1:20 titer that Gastro said he was not concerned with.
SO it seems I have a mild elevation of alk Phos....no symptoms.
New england Journal Of medicine mentions observation in mild (less the 1.5 ul) elevations of alp, with no other symptoms or high enzymes. What do you think of this?
My problem is gastro seems insistent on doing a Liver biopsy.
He mentioned that maybe another Dr. may be less aggresive (aggressive) and wait...."but what if it comes back to haunt you 5 years from now"
Im thinking wait 3 months and retest alk phos....he wants the liver biopsy now.
What would you recomend Doc? I think I should get a 2nd opinion.
Obviously concerned about hemangioma, bleeding and risk and also expense.
also it seems Ive been thourougly tested already.
If I were your patient, would you push for the Biopsy?
Thank You.
Im a male 44 years old.
Isoenzynes, which confirmed alk phos coming from Liver. Primary Care Dr. mentioned PBC. Referred to Gastroenterologist. Had 8 other blood tests, including ana, ama, hep panels...etc...etc. Was told I had a resolved HEP b. or was immunized...also had additional HepC, HEPB rna/dna etc..etc..
Was told other then hemangioma, Ultrasound, mri, catsacn looked good.
I assume that being a male and negative on ama test...pretty much rules out PBC.
Then had a MRCP(also normal)....all test have been normal. Other then asma that was >1:20 titer that Gastro said he was not concerned with.
SO it seems I have a mild elevation of alk Phos....no symptoms.
New england Journal Of medicine mentions observation in mild (less the 1.5 ul) elevations of alp, with no other symptoms or high enzymes. What do you think of this?
My problem is gastro seems insistent on doing a Liver biopsy.
He mentioned that maybe another Dr. may be less aggresive (aggressive) and wait...."but what if it comes back to haunt you 5 years from now"
Im thinking wait 3 months and retest alk phos....he wants the liver biopsy now.
What would you recomend Doc? I think I should get a 2nd opinion.
Obviously concerned about hemangioma, bleeding and risk and also expense.
also it seems Ive been thourougly tested already.
If I were your patient, would you push for the Biopsy?
Thank You.
Im a male 44 years old.
Doctor's Answer
by Kevin Pho, MD, Mar 18, 2006 12:00AM
, Mar 18, 2006 12:00AM
You have had a pretty comprehensive initial evaluation.
With the negative testing, the chances of PBC are less likely. Of course, it is impossible to be sure without a liver biopsy.
In cases like these, either approach (i.e. a liver biopsy or not), would be acceptable. The negative testing would make serial observation acceptable. However, the more aggressive approach of a biopsy would also be acceptable if there continues to be suspicion of PBC.
I would obtain another GI opinion if you are hesitant about the biopsy.
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.
Kevin, M.D.
kevinmd_b
With the negative testing, the chances of PBC are less likely. Of course, it is impossible to be sure without a liver biopsy.
In cases like these, either approach (i.e. a liver biopsy or not), would be acceptable. The negative testing would make serial observation acceptable. However, the more aggressive approach of a biopsy would also be acceptable if there continues to be suspicion of PBC.
I would obtain another GI opinion if you are hesitant about the biopsy.
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.
Kevin, M.D.
kevinmd_b
My problem now is my insurance only covers one gastro group.
Do you think that I can get unbiased 2nd opinion from someone in my GI's Practice. Only other alternative is to go outside my Providers.
Thanks
Thanks