My total ALP has slowly increased over the last 5 months, but "splitting out" those isoenzymes revealed nothing. I had a sonogram which indicated some non-alcoholic fatty liver and possibly some cirrhosis. Doctor followed with a CT scan, which showed NO kidneystones, gallstones, blockages, fluid buildup, etc. No mention was made of NAFLD or cirrhosis, but I've read CT scans don't detect that. I have no pain at all--there is some puffiness in my left leg. My doctor once said he would decide after the CT about a liver biopsy, but I've heard nothing, even after talking to his staff, who simply said, "The CT scan was normal." Am I safe to let this go?
No, you should not just let this go. Has your doctor considered your bones yet?
I would recommend you ask for a referral to a hematologist regarding this matter.
I have an old lab book, called "A Manual of Laboratory Diagnostic Tests", 2nd edition by Frances Fischbach. It states ALP testing is "an index of liver and bone disease when correlated with other clinical findings."
A. Elevated levels
1. Liver disease (correlates with abnormal liver function tests) An elevation of alkaline phospatase is often associated with elevated SGOT/AST and elevated bilirubin."
CN1952- did your doctor test your SGOT/AST and bilirubin and if so, with what results?
It says: "(a) Marked increases
(1) Obstructive jaundice (gallstones obstructing major biliary ducts; accompanies elevated bilirubin)
(2) Space-occupyng lesions of the liver such as cancer and abscesses
(3) Hepatocellular cirrhosis
(4) Biliary cirrhosis
(b) Moderate increases
(2) Cirrhosis of liver
(b) Moderate increases
(1) Osteomalacia (elevated levels help differentiate between osteomalacia and osteoporosis, in which there is no elevation)
3. Other diseases
(a) Hyperparathyroidism (accompanied by hypercalcemia)"
CN1952- Did your doctor check your calcium level and your parathyroid hormone level?
"(b) Infectious mononucleosis"
It also lists a number of drugs that can raise your alkaline phospatase, so if you are taking any medications, you might check with your pharmacist to see if any of them raise your ALP.
It says "all women have physiologically high levels of alkaline phospatase" and ALP "is slightly increased in older people". But you have been a steady increase, so I think you should definitely not let this go. I don't know if your possible cirrhosis is to blame in your situation or not but I think you should get that referral to a hematologist I mentioned! And what does the doctor say about your puffy leg or do they know about that?
Thanks for your response! Regarding the blood work, I've had CMP done 3 times. Absolutely everything is normal except for that ALP. I'm familiar with some of the things you mentioned, thanks to internet searches I started back in August--The only change I've had in meds is the addition of pravastatin for cholesterol control, but my ALP was just over "hi" already then. I even stopped taking any ibuprofen at all, but the ALP still rose. And online articles also increased my concern about bone ALP, since the GGT was normal. But when we tested the different ALPs (bone, liver, intestine) those numbers were normal! Yet, when I have the CMP done, the ALP keeps creeping up. The doc actually was the one who noticed the puffy leg, and I read online that can be tied in with liver trouble. But then, it can be tied in with other things, as well. Doctor said he would decide after the CT scan whether to refer me to have a liver biopsy done. I know it's not something they like to do routinely, but I also know it's the only way to determine cirrhosis and the degree of it. I'm just not sure now what to make of the funky sonogram compared to the CT scan. As I mentioned, when I called the office, I was just told "The CT was normal."
Just an FYI -- I always ask the hospital (I work there) for a copy of my test results so I can look up all the terms online. It also helps me be a little more informed when I visit my doctor afterward. And I usually get them well before I ever hear from the doc. :)
Granted, the wisest next step is to call the office, bypass the crabby chick and insist that the doc give me a call back so I can ask him point blank. I like my FP -- he has been taking things very seriously with what I consider to be other minor concerns -- that's probably why I tend to become less concerned if I don't hear from him. However, if I don't get a satisfactory response from him, I think I'll take your advice and ask for a referral to a specialist.
I truly appreciate your response -- thank you so much!
So, since your ALP had already gone high prior to the prevastatin, were you taking any other medication besides ibuprofen prior to that and if so, have you checked on possible effects on lab tests with those?
While it looked like MRI is not the best for each and every liver lesion, I had read about hemangiomas, as I have one, which MRI is better than CT on diagnosing, though anything smaller than a certain size is difficult to figure out (I have a smaller lesion of 8 mm which the radiologist is not sure of what it is). You might ask the doctor about MRI with and without contrast of the liver, especially since you say in your first post, that CT scans don't detect cirrhosis and not only that, your report of what your CT scan said does not seem to even MENTION if the liver was lesion free, so I wonder if the radiologist even bothered to pay enough attention to it. It would seem that would be a prime thing to look at and be detailed about, given your ALP level!
Also, one might ask the doctor about a scintigraphic bone scan.
And you don't just want to drop things with that puffy leg demonstrating something is wrong!
I'm taking two other meds, but I've been on those through other normal CMPs so I dismissed those as the culprit. And my brief explanation of my CT results didn't include everything--I was trying to indicate that it detected no "things" -- tumors, blockages, etc. Specifically, no masses or growth in the liver or kidneys, no gallstones or kidney stones, no biliary duct obstructions, no lymph node swelling. Also no abdominal fluid to would indicate advanced liver disease. Just a "tiny hiatal hernia," which explains my periodic mild heartburn. :) Conspicuously absent was any comment about fatty liver or cirrhosis, which, as I noted, I believe isn't diagnosed by CT. So while I'm happy with the results, I'm still wondering if I need a "next step" as far as the sonogram results. My online investigating tells me that imaging can rule out certain causes of liver trouble, but it can't show if there is inflammation or scarring.
I'm not trying to make a problem where there is none, but I know enough to realize that by the very nature of its job, the liver is sort of "key" to everything else in the body. And with fatty liver and possible cirrhosis, something's not quite right. I'm going to check with my doc today--if he blows me off (and I really don't think he will, although his staff would), I'll ask for a referral. And I'll get me a new FP. :)
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