Alcoholic liver disease presenting with marked elevation of serum alkaline phosphatase

1978 ◽  
Vol 23 (12) ◽  
pp. 1061-1066 ◽  
Author(s):  
Robert P. Perrillo ◽  
Ronald Griffin ◽  
Katherine DeSchryver-Kecskemeti ◽  
Jerrold J. Lander ◽  
Gary R. Zuckerman
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Serum Alkaline Phosphatase ◽  
Marked Elevation

Serum Gamma-Glutamyl Transpeptidase Activity as an Indicator of Disease of Liver, Pancreas, or Bone

1972 ◽  
Vol 18 (4) ◽  
pp. 358-362 ◽  
Author(s):  
Gifford Lum ◽  
S Raymond Gambino
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Viral Hepatitis ◽  
Bone Disease ◽  
Leucine Aminopeptidase ◽  
Serum Alkaline Phosphatase ◽  
Metastatic Carcinoma ◽  
Gamma Glutamyl Transpeptidase ◽  
Serum Alkaline Phosphatase Activity ◽  
Glutamyl Transpeptidase

Abstract Serum γ-glutamyl transpeptidase (GGT), leucine aminopeptidase, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase activities were assayed in controls and in patients with liver, pancreatic, or bone disease. GGT activity was above normal in all forms of liver disease studied (viral hepatitis, cirrhosis, cholecystitis, metastatic carcinoma to liver, pancreatic carcinoma, liver granuloma, and acute pancreatitis). GGT more sensitively indicated hepatic disease than did alkaline phosphatase, much more so than did leucine aminopeptidase. GGT was disproportionately more active in relation to the transaminases in cases of intraor extrahepatic biliary obstruction; the reverse was true in cases of viral hepatitis. GGT activity was normal in children, adolescents, and pregnant women, and in cases of bone disease and renal failure. Kinetic measurement of GGT activity offers a simple, sensitive, and direct means for distinguishing whether bone or liver is the source of increased serum alkaline phosphatase activity. Activity was highest in obstructive liver disease.

scholarly journals Evaluation of Serum Zinc Status and Serum Alkaline Phosphatase Activity in Alcoholic Liver Disease Patients - A Hospital Based Study from Chennai, Tamil Nadu

2021 ◽  
Vol 8 (24) ◽  
pp. 2100-2105
Author(s):  
Uma T ◽  
Nirmaladevi P ◽  
Shanthi R ◽  
Mahalakshmi R
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Phosphatase Activity ◽  
Alcoholic Liver Disease ◽  
Alkaline Phosphatase Activity ◽  
Serum Zinc ◽  
Meld Score ◽  
Gamma Glutamyl Transferase ◽  
Zinc Status ◽  
Glutamyl Transferase

BACKGROUND Alcoholism remains to be the major cause of morbidity and mortality throughout the world. Consuming alcohol is the potent etiological factor for the development of alcoholic liver diseases (ALD), ranging from fatty liver to hepatocellular carcinoma with varying rates of development in both genders depending on the quality, quantity, and duration of the drink. Zinc deficiency has been documented with the progression of alcoholic liver disease. It is also a well-known fact that zinc is a co-factor for enzyme alkaline phosphatase. This study aims to assess the zinc status and alkaline phosphatase activity in patients with various stages of alcoholic liver disease, correlate zinc with alkaline phosphatase activity, albumin, gamma glutamyl transferase activity, MELD score and duration of alcohol intake and analysing the need for evaluating zinc in these patients. METHODS This comparative observational study involves group I healthy controls and group II patients diagnosed to have ethanol related decompensated liver disease with or without portal hypertension for more than three years from the Department of Medical Gastroenterology, Government Medical College Hospital. 5 ml of venous blood in fasting state was collected from both groups and assayed for serum zinc, and serum alkaline phosphatase activity. The data was statistically analysed. RESULTS The study results demonstrate that higher percentage of patients with alcoholic liver disease have low serum zinc levels than healthy controls. Zinc when compared with variables like serum albumin, duration of alcohol intake, MELD score, serum gamma glutamyl transferase and alkaline phosphatase in the case and control groups were found to be statistically significant. CONCLUSIONS There is decrease in serum zinc level and increased alkaline phosphatase activity in patients with alcoholic liver disease. The statistically significant data is a strong rationale for evaluating the zinc status and thereby supplementing zinc to patients with alcoholic liver disease. KEYWORDS Alcoholic Liver Disease, Zinc, Alkaline Phosphatase, MELD Score

Primary biliary cholangitis

2020 ◽  
pp. 3127-3135
Author(s):  
Jessica K. Dyson ◽  
David E.J. Jones
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Serum Alkaline Phosphatase ◽  
Disease Diagnosis ◽  
Immunosuppressive Drug ◽  
Primary Biliary Cholangitis ◽  
Line Treatment ◽  
Antimitochondrial Antibodies ◽  
First Line ◽  
Intrahepatic Bile Ducts

Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic, cholestatic liver disease in which the biliary epithelial cells lining the small intrahepatic bile ducts are the target for immune-mediated damage, leading to progressive ductopenia and cholestasis. The cause is unknown but presumed to be autoimmune. The disorder affects women (>90% of cases) and usually has an insidious onset in middle age. Younger patients are less common but have a more aggressive disease course. Fatigue and pruritus are the most common presenting symptoms. Findings on examination vary widely, ranging from no abnormality to jaundice with hyperpigmentation, scratch marks, and rarely the features of advanced liver disease. Diagnosis of PBC is based on three criteria: (1) cholestatic liver function tests, with increases in serum alkaline phosphatase and γ‎-glutamyl transferase, (2) presence of serum antimitochondrial antibodies (found in more than 95% of cases), and (3) compatible liver histology. Many asymptomatic patients are recognized following the incidental discovery of antimitochondrial antibodies or elevated levels of serum alkaline phosphatase. First-line treatment is with ursodeoxycholic acid which can lead to significant improvement in liver biochemical values. Second-line treatment is with obeticholic acid. No immunosuppressive drug regimen has been proven effective. Progression may be slow, but eventually patients can develop cirrhosis. Cholestyramine is used as first line to treat pruritus. There is no recognized treatment for fatigue. Liver transplantation is indicated in some cases.

scholarly journals A Model Incorporating Serum Alkaline Phosphatase for Prediction of Liver Fibrosis in Adults with Obesity and Nonalcoholic Fatty Liver Disease

2021 ◽  
Vol 10 (15) ◽  
pp. 3311
Author(s):  
Ahmad Hassan Ali ◽  
Gregory F. Petroski ◽  
Alberto A. Diaz-Arias ◽  
Alhareth Al Juboori ◽  
Andrew A. Wheeler ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Serum Alkaline Phosphatase ◽  
Obese Patients ◽  
Nonalcoholic Fatty Liver ◽  
Significant Fibrosis

We assessed the relationship between serum alkaline phosphatase (ALP) and liver fibrosis by histology, in addition to other noninvasive parameters, in obese patients undergoing metabolic surgery. Patients scheduled for elective bariatric surgery were prospectively recruited from a bariatric clinic. An intraoperative liver biopsy was performed, and liver histology was evaluated by a pathologist blinded to the patients’ data. The endpoint was significant fibrosis defined as fibrosis stage ≥ 2. Independent predictors of fibrosis were identified by logistic regression. Two hundred ten patients were recruited. Liver histology revealed steatosis in 87.1%, steatohepatitis in 21.9%, and significant fibrosis in 10%. Independent predictors of significant fibrosis were ALP (Odds Ratio (OR) 1.03; 95% Confidence interval (CI), 1.01–1.05), alanine aminotransferase (OR 1.02; 95% CI, 1.01–1.03), HbA1c (OR 1.58; 95% CI, 1.20–2.09), and body mass index (OR 1.06; 95% CI, 1.00–1.13). A tree-based model was developed to predict significant fibrosis, with a receiver operating characteristic (ROC) area of 0.845, sensitivity of 0.857, specificity of 0.836, and accuracy of 0.931. The applicability of serum ALP as an independent biomarker of liver fibrosis should be considered in obesity surgery patients, and in the broader context of obese patients with nonalcoholic fatty liver disease.

Acute Hepatic Injury Associated with Varenicline in a Patient with Underlying Liver Disease

2009 ◽  
Vol 43 (9) ◽  
pp. 1539-1543 ◽  
Author(s):  
Andrew J Franck ◽  
Lisa R Sliter
Keyword(s):  
Alkaline Phosphatase ◽  
Smoking Cessation ◽  
Liver Disease ◽  
Hepatitis C ◽  
Alcoholic Liver Disease ◽  
Hepatic Injury ◽  
Liver Toxicity ◽  
White Male ◽  
Drug Induced ◽  
Acute Hepatic Injury

Objective: To report a case of acute hepatic injury associated with varenicline. Case Summary: A 53-year-old white male with underlying alcoholic liver disease and history of hepatitis C virus infection experienced elevated aminotransferase and alkaline phosphatase levels consistent with acute hepatic injury after initiation of varenicline for smoking cessation. The hepatic injury manifested 4 weeks after initiation of varenicline therapy at 0.5 mg once daily for 3 days, 0.5 mg twice daily for 4 days, and then 1 mg twice daily. Following discontinuation of varenicline, the patient's aminotransferase levels continued to rise for 2 days before steadily decreasing and returning to baseline levels in approximately 4 months. Alkaline phosphatase continued to rise for 8 days after discontinuation of varenicline before returning to baseline within 1 month. Rechallenge was not attempted. Discussion: Varenicline is a novel, first-line agent for smoking cessation. The presentation of this patient is most consistent with an acute hepatic injury related to drug toxicity. The pattern of the patient's elevated hepatic enzyme levels is not consistent with his underlying alcoholic liver disease or hepatitis C. Using the Naranjo probability scale, as well as the Counsel for International Organizations of Medical Science/Roussel Uclaf Causality Assessment Method algorithm for drug-induced liver toxicity, we determined that varenicline was the probable cause of the acute hepatic injury. Varenicline was a possible cause of the acute hepatic injury using the algorithm for drug-induced liver toxicity developed by Maria and Victorino. To our knowledge, this is the first report of acute hepatic injury associated with varenicline. Conclusions: While the benefits of smoking cessation are likely greater than the risk of hepatic injury, clinicians should be cognizant of this reaction associated with varenicline.

scholarly journals Diagnostic strategies and test algorithms in liver disease

1997 ◽  
Vol 43 (8) ◽  
pp. 1555-1560 ◽  
Author(s):  
Edgar R Black
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Serum Alkaline Phosphatase ◽  
Clinical Decision ◽  
Aminotransferase Activity ◽  
Hepatocellular Injury ◽  
Serum Aminotransferase ◽  
Diagnostic Strategies

Abstract As clinicians evaluate patients, they first develop problem lists based on the history, physical examination, and basic laboratory studies. Synthesis and analysis result in a differential diagnosis with associated disease probabilities. Experienced clinicians then selectively use diagnostic tests to rule in or rule out these possibilities. For example, in a patient presenting with jaundice, anorexia, fever, and abdominal pain, the relative increases of the serum aminotransferase activity and the serum alkaline phosphatase will help to guide the subsequent evaluation. If the aminotransferase activity is markedly increased, then the subsequent evaluation will be targeted toward identifying an etiology for hepatocellular injury. In contrast, if the alkaline phosphatase is markedly increased, then the evaluation would be targeted toward identifying an etiology for obstructive jaundice. This paper reviews clinical decision making, discusses characteristics of diagnostic tests, and presents examples of how basic clinical information can guide the use of the laboratory in evaluating patients with suspected liver disease.

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