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