hepatic and biliary disorders
The Asymptomatic Patient With Abnormal Liver Test Results
Alkaline phosphatase
Isolated elevation of alkaline phosphatase levels in an asymptomatic patient requires confirmation of hepatic origin by showing elevation of 5´-nucleotidase or gamma-glutamyl transpeptidase. If hepatic origin is confirmed, Imaging Tests of the Liver and Gallbladder , usually with ultrasonography or magnetic resonance cholangiopancreatography, is indicated. If no structural abnormality is found on imaging, intrahepatic cholestasis is possible and may be suggested by a history of exposure to drugs or toxins. Infiltrative diseases and liver metastases (eg, due to colon cancer) should also be considered. In women, antimitochondrial antibody should be obtained to check for Primary Biliary Cholangitis (PBC) . Persistent unexplained elevations or suspicion of intrahepatic cholestasis warrants consideration of liver biopsy. 