A 29-year-old gentleman with a history of extensive ulcerative colitis (UC) returns for a clinic follow-up. His disease is well controlled. He has no fever or abdominal pain.
•Temperature 36.8°C, pulse 72 bpm, BP 110/72mmHg, SaO2 98-100% on RA.
•Alert, no jaundice with no stigmata of chronic liver disease.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable, with no lymph nodes palpable.
•Cardiovascular: HS dual. No murmur.
•His chest is clear on auscultation.
•Abdominal examination reveals a soft, non-tender abdomen, with no organomegaly.
•No signs of oedema.
–WBC 9.7 x 109/L;
–platelets 265 x 109/L.
•ALP 350 IU/L.
•ALT 50 IU/L (baseline normal).
•Renal function is normal.
What are the common causes of increased ALP?
•Hepatocellular disease, e.g. cirrhosis, hepatitis, alcoholic liver disease.
•Infiltrative disease, e.g. TB, sarcoidosis.
•Primary biliary cirrhosis.
•Primary sclerosing cholangitis (PSC).
How would you evaluate the origin of ALP?