Cause of extremely low ALP on Liver Function Tests

[African1]

27 years old male, heavy drinker for the past 11 years.I have been having this terrible pain on the right side, just below the ribs, gets worse when laughing or when I sleep on the same side.

Also, my palms are red with visible dilated veins all over.

Went to the doctor, last year and an abdominal ultrasound was done, which showed no abnormalities.

Saw the GP again yesterday, because the pain is now becoming worse. No scan was done (doctor doesn't believe I have liver disease)

LFTs as follows;

ALT 21.9 U/L (Reference range 0-45)

AST 32.1 U/L (Reference range 0-35)

GGT 24.9 U/L (Reference range 0-55)

ALP 24.9 U/L (Reference range 64-309)

What can be the cause of extremely low ALP?

With AST/ALT ratio of 1.5, according to the internet it means I have cirrhosis

What can you say about that?

Help please!

[MINTVCX]

"With AST/ALT ratio of 1.5, according to the internet it means I have cirrhosis"Wrong conclusion.

[RugbyMama]

There are no pain receptors in the liver therefore the pain you're experiencing could be as a result of swelling/inflammation/something in your Glisson's capsule, this is the layer of tissue that surrounds your liver, pancreas, spleen and gall bladder. So it could be any one of those things causing your pain.

Please stop googling and speak to your doctor.

[African1 in reply to RugbyMama]

Thank you so much for the advice

[Kristian]

Low ALP doesn't necessarilly indicate liver disease. There are plenty of other causes with most common, according to my quick tinterweb search, being down to nutrition. Not unsurprising if you've been totting the alchoholic sauce a bit too much.

Don't jump to the ALT/AST ratio conclusion either. If you had cirrhosis it would've shown on your ultrasound. It didn't so that is highly unlikely to be present.

Hope thats a little bit helpful.

[African1 in reply to Kristian]

I understand now, it's very helpful. Thank you

[MINTVCX]

If we talk about Alcohol-related liver disease (ARLD) this ratio (typical above 2.0) is a sign of it. Nothing more. You cannot diagnose cirrhosis or even severe liver damage based only on this. It just does not work that way.

[Porcupine_Tree]

The best thing you can do is to stop drinking alcohol altogether..

[African1 in reply to Porcupine_Tree]

Yes, I will most definitely do that, thank you! I just hope it's not too late

[ScoobyPoodle1]

Hello African 1. I'm sorry to hear you're experiencing unexplained pain. Does the pain radiate in that area every time, or does it go into your back up toward your right shoulder blade? I had a possible blocked bile duct a a short time ago, and the pain radiated around the same area all the time. My husband had a gallbladder problem and the pain went into his back up towards the shoulder blade. I would suggest a second opinion with a different doctor. He may pick up on something your first doctor missed. Hope that's of help to you.

[African1 in reply to ScoobyPoodle1]

Yes, it just radiates around the same area. Thankfully, the pain is improving now

[ScoobyPoodle1 in reply to African1]

Glad it seems to be dissipating, but that can happen when a bile duct is partially blocked. So I would still suggest a second opinion. These pains can come and go.

[African1 in reply to ScoobyPoodle1]

Thank you! I will definitely do that. Will let you know how it goes

[African1 in reply to ScoobyPoodle1]

Had the second opinion today, was seen by a different doctor, who ordered blood test for Hepatitis B and C. Both came out Negative. Abdominal Ultrasound was done and no liver abnormalities were noted. However it mentioned of some little fluid seen above the liver, and sediments in the gallbladder suggestive of gallbladder sludge. Still don't understand what's causing it, I feel like there's something they are not telling me.

[ScoobyPoodle1 in reply to African1]

Hi. Glad the main tests didn't through up anything drastic. I'm no doctor but I can only tell you of my husbands experience. He passed alot of gallbladder sludge in his urine when he was in accute severe pain. That was the point I took him to A&E. His gallbladder was infected because the duct was blocked and, infact, it had perforated. On his scan it showed a pocket of fluid above the liver in the gallbladder area. He had to stay in hospital for 4 days to have intravenous antibiotics to stop him developing septis. They couldn't remove what was left of the gallbladder as it was stuck to the structures around it, and they still haven't removed it. This happened in July 2022, and though he still gets the occasional bout of pain, it's nothing like it was at that accute stage, and most of the time he has no problem. I think you should ask the doctor to fully explain the results, to help you understand better. My husband has had to make some changes to his diet, so I would ask for advice about that too. Good luck, keep me posted.

[Bikafella]

I know a lot of people here get obsessed with their blood test results and examine microscopically every up and down to help them understand what their body is doing. This makes them. worry unnecessarily that something dreadful is wrong with them, even after diagnosis by health professionals. I agree using Google for help on medical matters is dangerous for some people who can't differentiate relevant and non-relevant information. My transplant was exactly six years ago. I've never had normal blood test results - key indicators are looked at by my liver consultant. It's very rare to change my meds. I think you should trust your doctors to know what is relevant and what's not. You will worry yourself sick - not good.

[African1 in reply to Bikafella]

This is very helpful information. We should really rely on our doctors for medical information. It's just unfortunate that our time in the doctor's office is usually very limited. we normally don't ask all the questions we have for them

[Newton9878]

Do fibroscan for to know exact condition or srage of liver

[African1 in reply to Newton9878]

Okay, thanks

[JulyAugust]

My opinion is that it is possible you may have gallstones which can only be detected from having an MRI scan (not sure they would show up on an ultrasound). Sometimes gallstones can get trapped in the bile duct…that can also cause pain.

[African1 in reply to JulyAugust]

Okay thank you! I will bring it up with my doctor to hear what he has to say.