Alkaline Phosphatase (ALP) Elevation - Differential Diagnosis Algorithm ALP: - Enzymes that catalyze hydrolysis of organic phosphate esters - Increased ALP from organs with disturbance (obstructed liver) or increased stimulation (placenta/Bone growth) Alkaline phosphatase sources: - Highest • Bone • Liver (80%) • Intestine - Other causes of elevation: • Intestine • Kidney • Placenta • Leukocytes • Malignancy Most common symptoms of Intrahepatic cholestasis: - Fatigue - Pruritis History and Physical examination: - Pruritis - Cholestasis - Drugs - Pregnancy - Renal disease - Bone symptoms - Pain -> RUQ -> US/Surgical consult ALP elevation DDX of Hepatic source: - Drugs - Primary biliary Cholangitis (PBC) - Other granulamatous disease - Infiltrative diseases - PSC - Other biliary diseases/Bile duct stricture/Stones #Alkaline #Phosphatase #ALP #Elevation #Differential #Diagnosis #Algorithm #hepatology
