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Suggest Treatment For Diarrhea And Ulcerative Colitis

Posted on Thu, 1 Jun 2017

Question: I am a 20 year old female recently diagnosed with UC. In January I had bloody diarrhea and 20 or so times. since then. My blood work in January has my ALP as 192, AST as 23 and ALT as 56. Bilirubin and albumin normal. MY GI has ordered a MRCP (at my request) What is your opinion on the likelihood that I have PSC?

How likely, generally speaking, do UC patients with an ALP of about 200 have PSC?

Answered by Dr. Sunil (2 hours later)

Brief Answer:
Please mention the units in which levels are measured by the laboratory.

Detailed Answer:
Hello,
Thanks for selecting this forum.

As per your query,

Liver disease can be a complication of inflammatory bowel diseases, such as ulcerative colitis, liver blood test called alkaline phosphatase is usually abnormal in a patient with PSC.

However, it is a very non-specific enzyme hence further tests like MRCP are done to rule out the possibilities. ALP is just a screening test.

PSC is often seen in patients with ulcerative colitis having elevated liver enzymes so definitely going for MRCP is a good idea.

Alkaline phosphatase level should be increased at least 3 times the normal to have any significance.

If the increment is less then 3 times then the test has no significance in clinical diagnosis.
You have not mentioned the unit in which this test has been done. Please mention the unit used by the laboratory as results may vary based on them.

Secondly, every lab has its different range of normal values, so kindly attach/upload the reports here given to you by the lab for further comments in this regard. You can simply upload them to the reports section of this web page.

Awaiting,
Warm Regards.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Sunil (32 minutes later)

The ALP , AST and ALT all in U/L for units. the reference range for ALP is listed as 34-104, AST is 13-39 and ALT is listed as 7-52. I also forgot to mention that my Mono ABS was also elevated at 1.8 (reference range less than 1, Unit is K/ul. Neutrophils also high at 9.6 (2.1 to 8.1 range) K/ul. Thank you!

Dr XXXXXXX

Do you think my elevated Mono ABS level could have anything to do with my elevated ALP level?

Thank you.

Answered by Dr. Sunil (14 hours later)

Brief Answer:
Follow up.

Detailed Answer:
Hi again.
Your enzyme level is less then 3 times the normal.Hence it has no significant clinical value.
Mono ABS and elevation of neutrophils are indicator of ongoing infection in body.
You should get a blood cultre and sensitivity to see if any bacteria is involved or not.

However you can go for MRCP to make things much more clear.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sunil (1 hour later)

Yes I will go for the MRCP but do you think it is possible I could have had mononucleosis in January when I had the blood work done and that that could have elevated my ALK? I don't think I have any of the symptoms of mono now, but I wonder if I could have had mono and not known it? I have researched the symptoms of mono but in January I was feeling pretty bad in general from the colitis and also not sleeping as much so I don't know. I never thought of mononucleosis until I noticed the elevated mono abs and I don't know if 1.8 is significant. Thank you.

Answered by Dr. Sunil (21 hours later)

Brief Answer:
Follow up answer.

Detailed Answer:
Hi Dear,
Mononucleosis is associated with mild hepatitis so yes slight derangement of enzymes can also be attribute to that.
See we treat symptoms and patient as a whole.
Elevated live enzyme can be there in a numbe of condition ranging from jaundice to as serious as carcinoma.As the a doctor we first rule out the common disease and after that think of rare possibilities.Just because ABS level was slightly derange does not meansthat you hve mononucleosis.
Dignosis depends on investigation and symptoms both.
1.8 is just mildly elevated (borderline) and has nothing to do with clinical mononuceosis.

Hope i answere your query well.
Follow ups are welcome.

Regards.

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Above answer was peer-reviewed by : Dr. Kampana