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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Causes of an elevated alkaline phosphatase

Causes of an elevated alkaline phosphatase
Marked elevation
(≥4 times the upper limit of normal)
*
Extrahepatic biliary obstruction
Choledocholithiasis (most common)
  • Uncomplicated
  • Complicated (biliary pancreatitis, acute cholangitis)
Malignant obstruction
  • Pancreas
  • Gallbladder
  • Ampulla of Vater
  • Bile duct
  • Metastasis to perihilar lymph nodes
Biliary strictures
  • Primary sclerosing cholangitis with extrahepatic bile duct stricture
  • Complications after invasive procedures
  • Chronic pancreatitis with stricturing of distal bile duct
  • Biliary anastomotic stricture following liver transplantation
Infections
  • AIDS cholangiopathy
  • Ascaris lumbricoides
  • Liver flukes
Intrahepatic cholestasis
Drug and toxins associated with cholestasisΔ
Primary biliary cholangitisΔ
Primary sclerosing cholangitisΔ
Intrahepatic cholestasis of pregnancy
Benign postoperative cholestasis
Total parenteral nutrition
Infiltrative diseasesΔ
  • Amyloidosis
  • Lymphoma
  • Sarcoidosis
  • Tuberculosis
  • Hepatic abscess
Metastatic carcinoma to the liverΔ
Liver allograft rejection
Other cholangiopathies (eg, IgG4 cholangiopathy, ischemic cholangiopathy, COVID-19)
Alcohol-associated hepatitis
Sickle cell disease (hepatic crisis)
Nonhepatic causes
Transient hyperphosphatemia of infancy and childhood
Moderate elevation
(<4 times upper limit normal)
Hepatic causes
Nonspecific, seen with all types of liver disease including:
  • Hepatitis: viral, chronic, alcoholic
  • Cirrhosis
  • Infiltrative diseases of the liver
  • Hypoperfusion states: sepsis, heart failure
Nonhepatic causes
Physiologic (children and adolescents)
Third trimester of pregnancy
Influx of intestinal alkaline phosphatase after eating a fatty meal (individuals with blood type O or B)
High bone turnover
  • Growth
  • Healing fractures
  • Osteomalacia
  • Paget disease of bone
  • Osteogenic sarcoma, bone metastasis
  • Hyperparathyroidism
  • Hyperthyroidism
Extrahepatic disease
  • Myeloid metaplasia
  • Peritonitis
  • Diabetes mellitus
  • Subacute thyroiditis
  • Gastric ulcer (uncomplicated)
  • Extrahepatic tumors
    • Osteosarcoma
    • Lung
    • Gastric
    • Head and neck
    • Renal cell
    • Ovarian
    • Uterine
    • Hodgkin lymphoma
* The alkaline phosphatase value may vary and be <4 times the upper limit of normal at times (eg, early in the disease process).
¶ May cause an isolated elevation in hepatic alkaline phosphatase if partial obstruction.
Δ May cause an isolated elevation in hepatic alkaline phosphatase.
Alkaline phosphatase may be derived from several sites including the liver, bone, third trimester placenta, intestine, and kidneys. An elevation in alkaline phosphatase with a normal gamma-glutamyl transpeptidase or 5'-nucleotidase suggests a nonhepatic source of alkaline phosphatase.
Graphic 99099 Version 8.0

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