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ALP DIAGNOSTIC VALUE IN LIVER

DISORDERS

BY ELIJAH NKWENA & KOORAPETSE


TIDIMANE
INTRO…
ALP test measures the amount of this enzyme in the
blood
Found in bone, intestine and other tissues.
Used to detect liver disorders(hepatobilliary
obstruction) BUT mainly specific for bone disorders.
In conditions affecting the liver disease/damage to
hepatocytes ALP is released in increased amounts
into the blood.
Oftenly used to detect blockage of bile ducts since
ALP is in high quantities in edges of cells that joins
to form bile ducts
. Mostly done with other tests that checks for liver
damage e.g. AST,ALP,LDH& bilirubin.
Cont’d
 In hepatobiliary obstruction, cells lining the biliary
ducts induces the ALP synthesis.
 High levels of ALP is indicative of extrahepatic
obstruction rather than intrahepatic obstruction
InALP isoenzymes, 5-NT or gamma GT may be
necessary to evaluate the origin of ALP.
 liver disorders patients presents with:
• Weakness, fatigue ,Loss of appetite ,Nausea, vomiting,
Abdominal swelling and/or pain ,Jaundice, Dark urine,
light colored stool ,Itching (pruritis).all this signs &
symptoms calls for ordering ALP test.
LAB INTERPRETATION OF ALP RESULTS
• Varies as per lab
NORMAL
Adults 35-100IU/L,neonates-adolscents 2-3times adults.
• HIGH VALUES
• ALP is usually much less elevated than AST and ALT in most liver
disorders.
• In primary biliary obstructive cirrhosis .
• Deep jaundice in alcoholics with fatty liver is common due to bile
duct obstruction and concomitant alcoholic Pancreatitis or to
intrahepatic cholestasis caused by steatosis.
• In alcoholic hepatitis ALP values less than 3 fold elevated.
• In obstructive biliary cirrhosis elevations are modest less than 3-4
fold except during bouts of a secondary cholangitis.
Cont’d
• Recent or severe liver damage,e.g hepatitis,obstructive
post hepatic jaundice. when the obstruction is complete,
serum enzyme activity is almost always increased to levels
about 3-8 folds.
• ALP increased much more than ALT,AST if the blockage is
due to gallstones,and also elevated in liver carcinoma.
• Other diseases include:amyloidosis the degree of ALP
elevation may be striking up to 20 folds with little /no rise in
serum bilirubin values.
• ALP levels in micro nodular cirrhosis are usually normal/
mildly elevated.
• *pregnancy may increase ALP values also in children is
elevated.
Cont’d
• LOW VALUES
• Seen in obstructive jaundice especially when
the obstruction is incomplete.
*Low levels of ALP may be seen temporarily
after blood transfusions or heart bypass
surgery.
*A deficiency in zinc may cause decreased
level
REFERENCES

• Fischbach FT, Dunning MB III, eds. (2004). Manual of


Laboratory and Diagnostic Tests, 7th ed. Philadelphia:
Lippincott Williams and Wilkins.

• Pagana KD, Pagana TJ (2002). Mosby’s Manual of


Diagnostic and Laboratory Tests, 2nd ed. St. Louis:
Mosby.

• Donald m & Rosalki B,Enzyme tests in


diagnosis,1996,oxford university press,new york,USA