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    ALP and GGT

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    Razeen Riyasat
    This document discusses alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) levels and how they are used to evaluate elevated ALP. It notes that ALP is commonly elevated in liver and bone diseases, and measuring GGT can help determine if the source is the liver or bone. If both are elevated it indicates liver pathology, while isolated ALP elevation with normal GGT points to bone as the source. The document provides details on further evaluating and diagnosing elevated ALP of hepatic origin through imaging and testing.

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    © All Rights Reserved
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    ALP and GGT

    Uploaded by

    Razeen Riyasat
    45 views9 pages
    This document discusses alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) levels and how they are used to evaluate elevated ALP. It notes that ALP is commonly elevated in liver and bone diseases, and measuring GGT can help determine if the source is the liver or bone. If both are elevated it indicates liver pathology, while isolated ALP elevation with normal GGT points to bone as the source. The document provides details on further evaluating and diagnosing elevated ALP of hepatic origin through imaging and testing.

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    This document discusses alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) levels and how they are used to evaluate elevated ALP. It notes that ALP is commonly elevated in liver and bone diseases, and measuring GGT can help determine if the source is the liver or bone. If both are elevated it indicates liver pathology, while isolated ALP elevation with normal GGT points to bone as the source. The document provides details on further evaluating and diagnosing elevated ALP of hepatic origin through imaging and testing.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    45 views9 pages

    ALP and GGT

    Uploaded by

    Razeen Riyasat
    This document discusses alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) levels and how they are used to evaluate elevated ALP. It notes that ALP is commonly elevated in liver and bone diseases, and measuring GGT can help determine if the source is the liver or bone. If both are elevated it indicates liver pathology, while isolated ALP elevation with normal GGT points to bone as the source. The document provides details on further evaluating and diagnosing elevated ALP of hepatic origin through imaging and testing.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 9

    Alkaline Phosphatase (ALP)

    Gamma- glutamyl
    transpeptidase (GGT)
    Name: Razeen Riyasat Ali
    ID: 20180014
    Alkaline Phosphatase (ALP)

    • Normal Value: 30-130 units/L


    • Where is it present?
    - Liver (Predominantly)
    - Bones
    - Placenta -> During Pregnancy
    How will you know that elevated ALP is due
    to liver pathology or bone disease?
    • Measure Gamma-Glutamyl Transferase (GGT) or serum 5’-
    nucleotidase levels.
    • If ALP is elevated + elevation of GGT and/or 5’-nucleotidase = Liver
    pathology
    • If ALP elevated + ”NO” elevation of GGT and/or 5’-nucleotidase =
    Bone pathology
    What is the Differential Diagnosis if there is
    elevated ALP of hepatic origin?
    • Chronic cholestasis, the most common include bile duct obstruction,
    Primary Biliary Cholangitis (PBC), Primary Sclerosing cholangitis,
    certain drugs such as phenytoin
    • Infiltrative disease such as sarcoidosis or amyloidosis
    How will you elevaluate elevated ALP of
    hepatic origin?
    • Evaluation starts with RUQ ultrasonography to access hepatic
    parenchyma and bile ducts.
    • Biliary dilation -> Suggests extrahepatic cholestasis
    • Absense of biliary dilation -> suggests intrahepatic cholestasis
    • Extra-hepatic cholestasis causes include:
    • Choledocholithiasis – Most common
    • Malignant obstruction
    • Primary Sclerosing cholangitis with extrahepatic bile duct stricture
    • Chronic pancreatitis with stricturing at the distal bile duct
    What to do next in extra-hepatic Chlestasis?
    • If ultrasound suggests obstruction due to stone or malignancy then
    use endoscopic retrograde cholangiopancreatography (ERCP) to
    confirm the diagnosis and facilitate biliary drainage
    • Magnetic resonance cholangiopancreatography (MRCP) can also be
    used instead of ERCP
    • If MRCP or ERCP is negative for biliary tract disease then liver biopsy
    should be considered.
    What to do next if the elevation of ALP is due
    to intrahepatic cholestasis?
    • There are numerous causes for intrahepatic cholestasis. A px history
    can be used to identify the cause. If no cause is idenified then the
    following tests are required:
    • Anti-mitochondrial antibodies- suggests Primary Biliary cholangitis (PBC)
    • Test for hepatitis A,B,C and E
    • Test for EBV and cytomegalovirus
    • Pregnancy testing in woman of child bearing age who is not known to be
    pregnant.
    Gamma- Glutamyl Transpeptidase (GGT)
    • Normal Values:
    > Males: 8-61 units/L
    > Females: 5-36 units/L
    • Elevation of GGT is seen in:
    > Liver Disease
    > Pancreatic Disease
    > MI
    > DM
    > Renal Failure
    > Medications such as phenytoin and barbiturates
    • The usefulness of GGT is limited by its lack of specificity.
    • An isolated GGT elevation in the presence of normal liver should NOT lead to exhaustive workup for liver
    disease
    Reference
    • Friedman, L., 2021. Approach to the patient with abnormal liver
    biochemical and function tests. [online] Www-uptodate-
    com.unifiji.idm.oclc.org. Available at: <https://www-uptodate-
    com.unifiji.idm.oclc.org/contents/approach-to-the-patient-with-
    abnormal-liver-biochemical-and-function-tests?search=liver
    %20function
    %20test&source=search_result&selectedTitle=1~150&usage_type=de
    fault&display_rank=1#H150965033> [Accessed 26 July 2021].

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