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



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