4. Alkaline phosphatase

Abstract

A 35-year-old male presents to his primary care physician with complaints of fatigue, pruritus, abdominal pain, fevers, weight loss, and intermittent jaundice. Over the past 6 months he has lost 10 kg and his pruritus has been getting increasingly worse. He denies shortness of breath and his appetite has not changed. He has had some diarrhea that is occasionally associated with blood. He has not had any changes in his vision or hearing. He has never smoked and only drinks 2-3 beers on the weekends. He has never used illicit drugs and is married with one child. His father, paternal grandmother, and sister all have ulcerative colitis.Physical examination shows a thin male with scleral icterus and pale mucus membranes. His vital signs are normal, but he has a systolic ejection murmur. He has hepatomegaly with the edge of the liver being 5 cm below the costal margin. Upon examining his skin, excoriations are seen on his arms, legs, chest, and back.Laboratory tests performed on blood collected at his office visit show: hemoglobin 91 g/L, hematocrit 27%, white blood cell count 9.8 ×