Primigravida with ALP >8000. No hepatobiliary symptoms,LFT Normal. What to do next??

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**Maternal causes : •Non-hepatobiliary causes : *Vit D deficiency *Pernicious anaemia *IBD *Hyperparathyroidism *Malignancies : Ca breast, Myeloma & Mets *Hyperphosphatemia *Renal Osteodystrophy **Fetal causes : *Chromosomal anamolies •Investigate accordingly.
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Advise to drink filtered coffee thrice a day ,more folate rich foods such as leafy greens, legumes beets, bananas, papaya. Adopt a low fat, moderate carbohydrate diet, can help to treat. Avoid fruits and vegetables served with highcalorie sauces or added sugar, choose fiber rich wholegrains Look for bony lesion rheumatoid arthritis, vitaminD deficiency etc.
Consider... pregnancy associated intrahepatic cholestasis. Rule out other causes... nonhepatic causes of high ALP... ... bone Intestine Placenta.. All these tissues secrete ALP. Sug. Pelvic and abd usg Do Ggt Repeat LFT after 2 weeks
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Possibilities Gall stone Non hepatic cause such as bone MM Carcinoma HIV Bacteremia or septicemia Foetal chromosomal disorder
Go for fetal.chromosomal disorder
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usg done
Not till now.
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