From the Guidelines
The patient's laboratory values indicate mild liver dysfunction, and further medical evaluation is warranted to determine the underlying cause of the elevated bilirubin level. The alkaline phosphatase level of 82 is within normal range for adolescents, as levels are physiologically higher in childhood due to bone growth 1. However, the bilirubin of 1.7 mg/dL is elevated, suggesting potential liver dysfunction or other conditions such as Gilbert's syndrome, viral hepatitis, or medication effects.
Key Considerations
- The patient should be scheduled for additional liver function tests, including ALT, AST, GGT, and a complete blood count to further evaluate liver function.
- Ultrasound imaging of the liver and biliary system would also be appropriate to rule out structural abnormalities, as choledocholithiasis is a common cause of extrahepatic biliary obstruction and elevated ALP of liver origin 1.
- While waiting for the appointment, the patient should avoid alcohol, acetaminophen, and other potentially hepatotoxic substances to prevent further liver damage.
- No specific medication is recommended at this time without knowing the underlying cause, but the patient should be monitored for symptoms like jaundice, dark urine, light-colored stools, abdominal pain, or fatigue, which could indicate a more serious condition 1.
Next Steps
- Further medical evaluation and testing are necessary to determine the underlying cause of the elevated bilirubin level and to develop an appropriate treatment plan.
- The patient's clinical history and medications should be reviewed to help determine the etiology of the elevated bilirubin level.
- Imaging of the biliary tree may be necessary to determine the etiology of extrahepatic or intrahepatic cholestasis, if the liver is suspected to be the source of elevated ALP 1.
From the Research
Laboratory Results
- Alkaline phosphatase: 82
- Bilirubin: 1.7
Interpretation of Results
The provided laboratory results show an alkaline phosphatase level of 82 and a bilirubin level of 1.7 in a 16-year-old male. According to the study 2, alkaline phosphatase and bilirubin are common liver chemistries used to assess liver health.
- The study 2 defines hepatocellular injury as a disproportionate elevation of AST and ALT levels compared to alkaline phosphatase levels, and cholestatic injury as a disproportionate elevation of alkaline phosphatase level compared to AST and ALT levels.
- The study 3 found that levels of alkaline phosphatase and bilirubin can predict outcomes of patients with primary biliary cirrhosis and might be used as surrogate end points in therapy trials.
- The study 4 recommends that patients with abnormal liver test results should be evaluated to determine the etiology, and the initial evaluation should include a review of previous laboratory test results, medical and family histories, substance use, and drugs.
Possible Next Steps
Based on the provided laboratory results and the studies 2, 3, and 4, possible next steps could include:
- Further testing to determine the etiology of the abnormal liver test results, such as testing for viral hepatitis, nonalcoholic fatty liver disease, and autoimmune hepatitis 2
- Imaging studies, such as right upper quadrant abdominal ultrasonography, to evaluate liver health 4
- Monitoring of liver test results over time to assess for any changes or improvements 3