Evaluation of LFT:
In case of isolated elevation of alkaline phosphatase, the first step is to identify the source by
checking glutamyl transpeptidase (GGT) or 5'-nucleotidase test
If GGT is elevated, the ALPase is coming from liver, then next step is RUQ ultrasound
If GGT is found to be low, the ALPase is coming from the bones. Bony conditions that cause increased turnover like Paget disease should be suspected
Cholestasis
Cholestasis can arise secondary to hepatocellular dysfunction or intrahepatic or extrahepatic biliary obstruction.
Both obstructive and nonobstructive cholestasis are characterized by the deposition of bile pigment within the hepatic parenchyma and the presence of green-brown plugs in the dilated bile canaliculi.
Decreased bile flow --> intestinal malabsorption and nutritional deficiencies including fat-soluble vitamins A,D,E and K
e.g, expect to see osteomalacia (2° vit. D deficiency)
NAFLD is most likely due to peripheral insulin resistance that leads to increased peripheral lipolysis, triglyceride synthesis, and hepatic uptake of fatty acids.
This leads to intrahepatic fatty acid oxidation, which increases oxidative stress and proinflammatory cytokines (e.g. TNF-alpha). The end result is liver inflammation, increased fat accumulation in the liver, and fibrosis/cirrhosis.
EDCs, including BPA and environmental endocrine-disrupting heavy metals, are exogenous chemicals that can alter the hormone homeostasis in the endocrine system by affecting either hormone synthesis or receptor binding.