J.Jpn. Surg. Soc.. 53(10): 755-764, 1953

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Original article

A CLINICAL OBSERVATION ON ALKALINE PHOSPHATASE IN BILIARY DISORDERS.

Alkaline phosphatase activity in blood serum and in the bile contained in the choledochus and the gallbladder, was measured in 57 surgically treated cases of the disease of the liver and biliary tract, 7 cases of hepatic diseases who had received no such treatment, and 19 controls with other surgical diseases.
Obstruction of the common bile duct was variously classified according to its cause in each case, and the increase of the activity in question in blood serum was examined severally. It was 100% in cases of tumor, 84% in those of calculi, and 67%, an extraordinary rise, in cases of intrusion of a strayed roundworm in the common bile duct.
The enzyma activity in blood serum averaged 22.3 units in 19 cases of obstruction of the common bile duct accompanied with jaundice, and 5.8 units in 7 cases of hepatocellular jaundice. These results seem to have an important significance as contributing something to the differential diagnosis of jaundice.
Serum alkaline phosphatase as measured, in 22 cases of cholecystitis with no manifest presence of obstruction in the major bile ducts, showed a slightly abnormal upward tendency in nearly half the cases, and averaged 8.4 units.
Enzyma activity in bile of the gallbladder was observed to decline in prportion to the severity of the disease of the organ.
It was noted that serum alkaline phosphatase, once increased by cholelithiasis, occasionally takes a long time to be restored to normal even when cholecystectomy, choledochotomy, and artifical formation of biliary fistula after removal of calculi are enforced.
The foregoing facts seem to suggest that liver functfon as well as obstruction of the bile duct may reasonably be taken into account in considering the cause of increase of serum phosphatase.
(author's abstract)

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