Question

A woman in her third trimester of pregnancy experiences gastroenteritis with vomiting and diarrhea. Her physician orders a hepatic function panel. ALT and AST are normal but her alkaline phosphatase (ALK) is twice normal. Total and direct bilirubin are normal. What is the significance of the ALK elevation?

consistent with biliary tract disease

consistent with intrahepatic cholestasis of pregnancy

consistent with fatty liver of pregnancy

none of the other choices

Answer 1

D. none of the other choices is the correct answer.

This is because , in women normally the ALK is elevated in the late trimester of the pregnancy due to certain factors, like fetal growth and bone development and also due to the production of certain placental isonenzymes. The placental isonenzymes and the fetal growth will elevate the serum ALK level. Therefore the ALK level elevation in pregnancy is said to be normal. ALK test is not at all a correct test to diagnose any of the hepatic or bone diseases during the third trimester of pregnancy in a women.

The other options are REJECTED because:The 3 options also causes elevates the ALK value but it cannot be a proper diagnosis of the hepatic and  bone diseases.

A.* consistent with biliary tract disease - The ALK level will be elevated in the case of biliary tract disease but it is not possible to distinguish with the normal elevation of ALK in third trimester.

B.* consistence with intrahepatic cholestasis of pregnancy- It also elevates the ALK level in blood but it also cannot be distinguished from the normal ALK elevation in pregnancy.

C.* consistence with fatty liver in pregnancy- The fatty acid in pregnancy might cause an increase of ALK in serum upto 10 times the normal value. Here the patient is only having twicw the normal value of ALK .

None of other options is the correct answer. The significance of ALK value elevation says that it is a normal condition that occures in a women who are carrying at third trimester of pregnancy.