Lack of diagnostic significance of serum alkaline phosphatase values in differentiating hepatocellular and obstructive jaundice

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ELEVATION of serum alkaline phosphatase values occurs in a number of diseases associated with osteoblastic activity, as well as in obstructive, infiltrative, and parenchymal diseases of the liver and the biliary tract. The report of Roberts,1 in 1930, that serum alkaline phosphatase values were elevated in patients with obstructive jaundice, attracted considerable attention. Since then the serum alkaline phosphatase content has been used widely in the differential diagnosis of jaundice.

Great increase in serum alkaline phosphatase content has been thought to be indicative of obstructive jaundice. When there are highly elevated values in hepatic disease, the physiologic mechanism has been considered “biliary obstructive” in nature, as in cholangiolytic hepatitis and biliary cirrhosis. Roberts,1 and Rothman, Meranze, and Meranze2 believed that there was a sharp demarcation in this regard between obstructive and hepatocellular jaundice. They found values greater than 10 units per 100 cu mm (modified Roberts’ method) in 25 of 29 patients with obstructive jaundice, and 10 units or less in 18 of 24 patients with hepatocellular jaundice. In differentiating between these two types of jaundice, Sherlock3 preferred an arbitrary dividing line of 30 King-Armstrong units. She believed that in obstructive jaundice, levels are usually more than 30 King-Armstrong units or 10 Bodansky units, and that in hepatocellular jaundice they are usually less than 30 King-Armstrong units. She stated that “Unusually low levels in obstructive jaundice are more frequent than unexpectedly high values in hepato-cellular jaundice.” Cantarow and Nelson4 found wide overlapping of alkaline phosphatase values in obstructive and hepatocellular . . .



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