Managing the patient with an abnormal liver test: Part 2, alkaline phosphatase elevations and liver enzyme abnormalities in pregnancy

Eugene R. Schiff, Julie Foont

Research output: Contribution to journalShort survey

Abstract

The first step in the workup of a patient with a persistent asymptomatic alkaline phosphatase (ALP) elevation is to measure gamma-glutamyltranspeptidase to determine whether the elevation is liver-related or bone-related. Fatigue is a common early symptom in patients with biliary tract disease; pruritus usually develops later. In middle-aged women, primary biliary cirrhosis (PBC) is the most likely cause of an asymptomatic ALP elevation. Primary sclerosing cholangitis (PSC) occurs most often in younger men. If you suspect PBC, order a test for antimitochondrial antibodies; a positive result increases the likelihood of the diagnosis. PSC is best diagnosed by cholangiography. Liver function test abnormalities frequently occur during pregnancy. Causes can include non-pregnancy-related illnesses (such as hepatitis C), the normal pregnancy-related rise in ALP levels, hyperemesis gravidarum, cholestasis of pregnancy, HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count), and acute fatty liver of pregnancy. The last 2 disorders are obstetrical emergencies and require prompt delivery.

Original languageEnglish (US)
Pages (from-to)41-44
Number of pages4
JournalConsultant
Volume48
Issue number1
StatePublished - Jan 1 2008

Keywords

  • Cholangiography
  • Cholestasis of pregnancy
  • Gamma-glutamyl transpeptidase
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis

ASJC Scopus subject areas

  • Medicine(all)

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