Clinical QuickieLiver/GI
Alkaline Phosphatase + Bilirubin
The pattern matters more than either number alone.
Confirm where the ALP is coming from
Alkaline phosphatase can be hepatic or nonhepatic. Pair it with the rest of the liver panel and, when needed, a hepatic-source marker.
Direct vs indirect bilirubin changes the differential
Predominantly unconjugated bilirubin points toward production/conjugation issues; conjugated bilirubin raises concern for hepatobiliary excretion or cholestatic disease.
Look for a cholestatic pattern
ALP-predominant elevation with bilirubin elevation should prompt attention to obstruction, cholangitis, medication effects, infiltrative disease, and other cholestatic processes.
Symptoms determine urgency
Jaundice plus fever, RUQ pain, hypotension, confusion, or a rapidly worsening cholestatic pattern is different from an incidental stable abnormality.
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