ALP (alkaline phosphatase) is an enzyme produced in several tissues, primarily the liver and bones. Elevated ALP can occur when the liver’s bile ducts are obstructed, during active bone growth or repair, or in certain physiological states like pregnancy.
Key insight: ALP by itself doesn’t specify the cause — pairing it with
GGT or other markers like
bilirubin helps identify the source of elevation.
Common reasons ALP is high
- Liver or bile duct obstruction
- Gallstones or bile flow impairment
- Bone turnover (growth, fractures, Paget’s disease)
- Pregnancy (placental ALP)
- Healing fractures or recent bone injury
- Certain medications (anticonvulsants, antibiotics)
How to interpret ALP with other markers
- High ALP + High GGT → liver or bile duct cause likely
- High ALP + Normal GGT → bone source likely
- ALP + Bilirubin ↑ → possible cholestasis or bile obstruction
When to follow up or retest
- Persistent elevation → may require imaging or further enzyme studies
- Mild, isolated ALP elevation → often rechecked after a few weeks
- In children or pregnancy → usually physiological (normal)
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