A 60yearold woman had a rectal carcinoma removed surgically

A 60-year-old woman had a rectal carcinoma removed surgically. There was no evidence of spread and her LFTs at the time were normal. At follow up 3 years later however, the following results were noted: Test Results Bilirubin 20 µmol/L AST 23 IU/L Alkaline Phosphatase 820 IU/L 1. How would you interpret theses results? 2. What pattern of liver dysfunction is shown? 3. What is a possible cause? 4. What further investigations are needed?

Solution

1. Interpretation of the Test results:-

Bilirubin: high

AST: Normal

Alkaline Phosphatase: Very HIgh; above 650 IU/L

The Liver function tests are not normal indicating Liver dysfunction. High levels of alkaline phosphatase (ALP) and bilirubin are a direct indicator of Liver damage.

2. The bilirubin level is almost doubled. The bilirubin level increases in case of rbc turnover. ALP levels above 650U/L may be considered as the indicative of the metastasis in Liver.

3. The ALP level is used for the prognosis of colorectal cancer. However, metastasis of the Liver may also be the possible cause, since ALP levels above 650U/L may be considered as the indicative of the metastasis in Liver.

4. The patient should go for CT-Scan or MRI of the whole abdomen. In case any new tumorous growth is found, the patient should immediately go for FNAC for detection of metastasis.