title: Approach to a patient with elevated serum alkaline phosphatase.
abstract: Cholestasis develops either from a defect in bile synthesis, impairment in bile secretion, or obstruction to bile flow, and is characterized by an elevated serum alkaline phosphatase and gamma-glutamyltransferase disproportionate to elevation of aminotransferase enzymes. Key elements to the diagnostic workup include visualization of the biliary tree by cholangiography and evaluation of liver histology. The hope is that recent advances in understanding the genetic factors and immune mechanisms involved in the pathogenesis of cholestasis will lead to newer therapeutic interventions in the treatment of these diseases.
authors.affiliation: Department of Gastroenterology, Center for Liver Disease, Digestive Disease Institute, Seattle, WA 98111, USA.
authors.forename: Asma
authors.initials: A
authors.lastname: Siddique
authors.forename: Kris V
authors.initials: KV
authors.lastname: Kowdley
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000628:therapy; D015209:Cholangitis, Sclerosing / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D002779:Cholestasis / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000175:diagnosis / Q000201:enzymology / Q000628:therapy; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology / Q000628:therapy*; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D012507:Sarcoidosis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000469:Alkaline Phosphatase