Patient History
The patient's medical history involved a resected colorectal carcinoma at the age of 60, with no evidence of metastatic disease. Liver function was normal at the time of surgery. Three years later, the female patient was found to have serum bilirubin levels of 20 ?mol/L. The serum levels for aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were 23 U/L and 820 U/L, respectively.
Interpretation of the Laboratory Tests
High serum levels of ALP can indicate the presence of disease in the liver, bone, intestinal tract, and/or parathyroid, but the most common use for this assay is to detect disease of the hepatobiliary tract (Tietz, 1999, p 676). This is because the liver will respond to any obstruction in the biliary tree by producing more ALP, and these levels can be especially high if the blockage is extrahepatic (> 3 times the upper limit of the normal range). The normal range for women between the ages of 61 and 65 is 50-130 U/L, which is the age of the patient at the time of the most recent test. The patient's serum ALP levels are therefore 6-fold higher than the upper limit of the normal range. This level of ALP is consistent with a number of diseases and conditions, including extrahepatic obstructions like stones or a tumor of the pancreas head, or osteogenic bone cancer. The patient's ALP levels are not consistent with Paget's disease, because this condition tends to produce serum levels reaching 10 to 25 times the normal upper limit (Tietz, 1999, p. 677). The presence of disease affecting hepatocytes is unlikely given how high the ALP levels are, but this possibility can't be eliminated using this test alone. The sources of serum ALP can also be discriminated to some extent through laboratory testing, because different ALP isoenzymes are produced by the liver, bone, and placenta. This test can help discriminate between liver or bone diseases, including malignancies, or ectopic expression of the placental form (Regan isoenzyme) by other malignancies.
Assuming the bilirubin assay results are for total bilirubin, then the patients serum levels are slightly elevated (17%). The upper limit of the normal range for adult females is 17.1 ?mol/L (Tietz, 1999, p. 1170),...
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