Q: I am a 34-year-old male. I underwent a Master health check-up. The report shows that my total bilirubin is 1.5, direct bilirubin is 1.0 and alkaline phosphatase is 282. Rest is normal. The doctor has advised me to get a check-up done after two weeks. What does my report indicate?

A:The liver performs a broad range of functions and the diagnosis of liver disease is made by taking into consideration the history of a patient, a complete physical examination, and a series of laboratory tests that evaluate liver function. The tests performed (both invasive & non-invasive) are guided by the clinical presentation of a patient. Bilirubin is a breakdown product of haemoglobin that is formed in the liver. Normally, about 1% of aged RBCs are lost daily and the resulting bilirubin leaves the body in the stool. If the load of bilirubin is too much for the liver to handle, it builds up in the blood resulting in jaundice. The blood test detects the total amount of bilirubin present (total bilirubin) and a fraction that is water soluble (direct reacting). Its level may rise due to premature destruction of red cells (haemolytic anaemia), diseases of the liver (hepatic) or diseases outside the liver preventing bilirubin excretion into the gut (post-hepatic). Alkaline phosphatase is an enzyme associated with the biliary tract and is also found in bone, intestine, kidney and the placenta. Its levels may thus rise due to diseases affecting the liver, bone, kidney, etc. Increased levels due to liver disease suggest inflammatory conditions affecting the biliary tract. You need to discuss with your doctor as he / she would be best placed to advise you.