The Case of the Elevated Alkaline Phosphatase

The Case of the Elevated Alkaline Phosphatase
I’m going on four months with elevated liver enzymes. My aspartate aminotransferase and alanine aminotransferase fluctuate between normal to above normal. My alkaline phosphatase steadily remains triple to quadruple the normal level. I continue getting biweekly bloodwork to watch for any changes. My liver biopsy in early July didn’t reveal any signs of rejection, recurrent primary sclerosing cholangitis, fatty liver disease, or other disorders. The sonographer who performed the ultrasound to guide the biopsy needle even praised how beautiful my liver was. Having run out of options, the hepatology team is taking a wait-and-see approach. If my alkaline phosphatase remains high but stable, they’ll keep an eye on my bloodwork. However, if my numbers continue to rise, they’ll insert a stent in my slightly dilated biliary duct. In the meantime, I’ve started my own investigation. Like a detective, I’m combing for clues that my doctors might’ve missed. It’s not that I don’t trust their expertise. I just have more of a vested interest. I got a new lead a couple of weeks ago during my annual nephrology appointment. My nephrologist was pleased with my normal renal function but expressed concern about my alkaline phosphatase. After I told him my liver team was aware of it, he commented that the intestines also produce alkaline phosphatase. I had recently discovered the enzyme is found in bones as well and had questioned my team about it. However, learning about intestinal alkaline phosphatase piqued my curiosity. My liver enzymes had increased as my flare subsided. Was there a correlation? What is alkaline phosphatase? The four types of alkaline phosphatase are distinguished between tissue-nonspecific and tissue-specific. Tissue-nonspecific alkali
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