Cholestatic hepatobiliary disease

Deficiency develops in patients with severe fat malabsorption, cystic fibrosis, chronic cholestatic hepatobiliary disease, and in two rare groups of patients with genetic diseases ... 

The Increase In AP activity is stimulated by bile acids. A rise in bile acids, which is considered to be the most sensitive and earliest marker of cholestasis, precedes any elevation in AP. The latter derives from enzyme synthesis with increased secretion into the blood. Under pathological conditions, bile duct AP is formed, which is a sensitive marker for hepatobiliary diseases, cholestasis and space-occupying lesions of the liver. The sensitivity is 80-100% in cholestatic diseases. AP activity is usually higher in obstructive jaundice and cholangitis than in intrahepatic obstructions, and it is highest in the vanishing bile duct disease or in complete obstruction. (13, 39, 41) (s. tabs. 5.9 13.2-13.4)... 

Elevated LAP values are found predominantly in biliary and cholestatic diseases - in accordance with AP. In liver diseases due to alcohol abuse, LAP values are exhibited both more frequently and with higher values than AP. In hepatitis mononucleosa, LAP is generally also more clearly elevated than AP. Significant increases in LAP are found in pancreatic and breast cancer as well as in collagenoses of the vascular type. LAP is not found in bone there is no evidence of elevated LAP in bone diseases. Normal LAP in connection with an increase in AP consequently rules out hepatobiliary diseases and requires further investigation. In these cases, parallel determination of AP and LAP is advisable. 

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