Hello! I have been a doctor for 21 years. My name is Georgy Olegovich Sapego. In this article I will talk about alkaline phosphatase.
Alkaline phosphatase is an enzyme found in the liver, bones, and intestines. In fact, these are several similar enzymes at once. They know how to split phosphate from different molecules, and they are best at doing this in an alkaline environment. Until now, we have not found out exactly what these enzymes are for.
Inside the liver, alkaline phosphatase is involved in the work of the biliary tract. In the intestines, it helps bacteria to peacefully coexist with us. Without alkaline phosphatase, the intestine can become inflamed. Alkaline phosphatase is also involved in the construction of bones.
Most often, alkaline phosphatase is determined to detect cholestasis, that is, a violation of bile flow.
It was once thought that alkaline phosphatase literally dumped from a damaged liver into the bloodstream. Then they decided that the diseased liver simply could not cope with the removal of alkaline phosphatase from the blood. It is now believed that bile stasis causes the liver to synthesize more alkaline phosphatase. Therefore, its level in the blood increases.
In the 15-50 age group, alkaline phosphatase is higher in men than in women.
In children, alkaline phosphatase sometimes rises unpredictably. This is usually due to bone growth and this is normal.
In people over 60 years of age, alkaline phosphatase is one and a half times higher than in young people. Moreover, in older men, it enters the bloodstream from the liver, and in older women from the bones.
In pregnant women, alkaline phosphatase can be twice the normal value. In them, it enters the bloodstream from the placenta.
Very noticeable increase
It is rather a violation of the outflow of bile. In about 75% of people with cholestasis, alkaline phosphatase will increase 4 times the normal value.
This happens when the bile ducts are blocked by a stone or blocked by a tumor. If you try very hard, then you can get a serious increase in alkaline phosphatase with alcoholic hepatitis.
Moderate increase
If alkaline phosphatase is less than 4 times higher than normal, then it can be any liver disease.
Sometimes such an increase occurs in members of the same family without any liver disease. It has something to do with genetics.
Well, why is all this necessary?
If alkaline phosphatase rises on every occasion, what good is it? The fact is that sometimes alkaline phosphatase rises in isolation. That is, no other analyzes show anything yet, and the alkaline phosphatase has already "got out". And it could be a sign of a serious liver disease. This happens, for example, if a stone or tumor only partially blocks the outflow of bile.
So the determination of alkaline phosphatase will not be abandoned.
Low level
Sometimes alkaline phosphatase is below normal. This happens with Wilson's disease (I have a separate article about this disease), with a decrease in thyroid function, with malignant anemia, with a lack of zinc.
Non-hepatic alkaline phosphatase
More often it enters the bloodstream from the bones. This happens after fractures, with various tumors in the bones, an increase in the function of the parathyroid glands.
Intestinal alkaline phosphatase
It often rises after eating fatty foods. This happens with members of the same family. If alkaline phosphatase decreased after fasting, then this was definitely due to the intestines.
What to do with elevated alkaline phosphatase?
Pregnant women don't bother too much. The rest of the people are asked to refrain from eating and are tested again.
If, together with alkaline phosphatase, other similar indicators increase, then the matter is in cholestasis. After that, the liver continues to be examined.
If only one alkaline phosphatase has increased, then it is more likely in the bones. Then they start looking for something that can destroy bones.
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Wilson-Konovalov disease
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