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Richard Han
Richard Han, Board Certified MD
Category: Medical
Satisfied Customers: 181
Experience:  Pediatrician at the Banner Health Center- Surprise, AZ
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I'm 48 years old. I just had the blood work and urine come

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Hello. I'm 48 years old. I just had the blood work and urine come back from a physical. It was perfect, except for a moderately elevated Alkaline Phosphtase. It was 214. I just met with my doctor and he was as confused as me. No other liver enzymes, Bili, AST, ALT, were abnormal, nor was the rest of the blood work. He mentioned a gall stone and in extreme cases cancer, which obviously scared me. He didn't think it was bone related. I play a lot of sports and have should impingement and some painful heels, but that is about it.I'm heading for an abdominal ultrasound tomorrow and would love a little piece of mind.
I have no symptoms, nor have I ever had symptoms like abdominal pain, jaundice, itching, etc. Nor, have I ever had abnormal blood work. Last year the ALP was 90. PSAs have always been great, including the one from this one. Any ideas? The cancer part was a little unnerving.
Customer: replied 11 days ago.
I am male, obvious by the PSA. My doctor also mentioned he is leaning false positive on the blood test because I have no other symptoms or abnormal blood work and urine.
Hello my name is***** am a board-certified physician and I am happy to help you. I agree with your doctor, very likely a false positive on the elevated ALP with all otherwise normal liver function test results. The ultrasound is a prudent measure to check on the liver and gall bladder anatomy, but the likelihood of cancer is extremely low.
Can I help with anything else?
Customer: replied 11 days ago.
I appreciate your help. Thank you. My doc was completely perplexed and he's a really good doc. Just one more thing. Would a gallstone that only partially blocks the duct give a raised ALP, but no rise in Bilirubin? I've never had, that I know of, a gall stone, and as I said no symptoms ever of it.
You’re very welcome. It is possible since elevations of ALP imply gall bladder inflammation while a rise in bilirubin would suggest either bile duct obstruction or a problem with liver function. Many people have “silent” gallstones, i.e. small ones that do not cause any symptoms. The ultrasound can help detect those.
Any other questions?
Customer: replied 11 days ago.
Sorry. Last one. Likely anything Pancreas related?

No need to apologize! Without any symptoms of abdominal pain, nausea or vomiting, very unlikely pancreas related. You doctor could have or can add on two simple blood tests called an amylase and lipase, which checks on enzymes specific to the pancreas. Elevated levels would suggest pancreatitis, but again, with no actual symptoms, highly unlikely. Can I help with anything else?

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Customer: replied 11 days ago.
Thank you. You've been great. Have a good night. I may ask more again later.
Customer: replied 11 days ago.
I forgot to ask you. Is a 214 considered really high? I hate being an internet doc, but have read it's not a great worry until greater than 3 times above normal. When is it time for a lot of concern?
214 is about twice normal, so it is high but not terribly. You read correctly, 3x normal is usually where ALP heads when there are gallstones blocking things up. It can climb much higher, around 10-12x normal in serious obstruction. I’d say yours isn’t too bad.
Customer: replied 11 days ago.
Thank you!
You’re welcome.