41

Case 41


History



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.


Physical examination


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.


Investigations


CBC:


WBC 9.7 x 109/L;


haemoglobin 10g/dL;


platelets 265 x 109/L.


Bilirubin 15μmol/L.


ALP 350 IU/L.


ALT 50 IU/L (baseline normal).


Renal function is normal.


What are the common causes of increased ALP?


Physiological.


Adolescence.


Pregnancy.


Pathological.


Bile obstruction.


Hepatocellular disease, e.g. cirrhosis, hepatitis, alcoholic liver disease.


Drug-induced.


Hepatocellular carcinoma.


Infiltrative disease, e.g. TB, sarcoidosis.


Primary biliary cirrhosis.


Primary sclerosing cholangitis (PSC).


Bone disease.


How would you evaluate the origin of ALP?


ALP isoenzyme.


Gamma-glutamyltransferase (GGT).

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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 41
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