From the Guidelines
These lab values suggest liver dysfunction that requires prompt medical evaluation, and you should contact your healthcare provider immediately to discuss these results. The elevated total bilirubin (1.8 mg/dL), direct bilirubin (1.0 mg/dL), alkaline phosphatase (206 U/L), and AST (61 U/L) indicate potential liver disease or biliary obstruction 1. While waiting for medical consultation, avoid alcohol, acetaminophen, and other potentially hepatotoxic medications. Stay well-hydrated and monitor for symptoms like jaundice, dark urine, light-colored stools, abdominal pain, or fatigue.
Some key points to consider:
- The pattern of elevation (with both direct bilirubin and alkaline phosphatase being high) suggests a possible cholestatic process, which could be due to bile duct obstruction, medication effects, or certain liver diseases 1.
- Your doctor will likely order additional tests such as ALT, GGT, albumin, and possibly imaging studies like ultrasound or CT scan to determine the underlying cause 1.
- The interpretation of all abnormal liver chemistries must be taken in the clinical context of a given patient, and the initial evaluation of abnormal liver tests includes a detailed history, inventory of medications, and a physical examination 1.
- If the initial studies are unrevealing, a reasonable approach may include close clinical follow-up, and if significant symptoms or evidence of chronic or decompensated liver disease are present, a more expeditious and complete initial diagnostic evaluation is typically warranted 1.
Given the most recent and highest quality study available 1, it is essential to seek medical attention promptly to determine the underlying cause of these lab results and to initiate appropriate management to prevent potential complications and improve outcomes.
From the Research
Laboratory Results
- Total bilirubin: 1.8
- Direct bilirubin: 1.0
- Alkaline phosphatase: 206
- AST: 61
Interpretation of Results
The patient's laboratory results show elevated levels of alkaline phosphatase and AST, which may indicate liver disease or damage 2, 3. The total and direct bilirubin levels are also slightly elevated, which could suggest a problem with the liver's ability to process bilirubin 2.
Possible Causes
The pattern of liver test abnormalities may suggest the underlying cause of the liver disease, such as hepatitis, biliary obstructions, or infiltrative liver disease 2. However, further diagnostic evaluation is needed to determine the etiology of the abnormal liver test results 4, 3.
Next Steps
The initial evaluation should include a review of previous laboratory test results, medical and family histories, substance use, and drugs, including over-the-counter drugs and herbal supplements 3. Additional tests and imaging should be based on patient-specific risk factors and the pattern of abnormal liver test results 3.
Treatment Options
Ursodeoxycholic acid may be a potentially useful drug for chronic liver disease, as it has been shown to improve liver function indices in both cholestatic and inflammatory chronic liver diseases 5, 6. However, the dosage and effectiveness of ursodeoxycholic acid may vary depending on the specific liver disease and patient population 5, 6.