Increases of up to 3 times normal occur in many liver disorders, including Chronic cholestatic liver disorders with hepatitis (ie, viral hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, drug-induced liver injury) Cirrhosis Space-occupying lesions (eg, carcinoma) Infiltrative disorders (eg, amyloidosis, sarcoidosis, tuberculosis, metastases, abscesses) Syphilitic hepatitis (alkaline phosphatase may be disproportionately elevated compared with modest changes in other liver tests) Post-liver transplant rejection Isolated elevations (ie, when other liver test results are normal) may accompany Focal liver lesions (eg, abscess, tumor) Partial or intermittent bile duct obstruction (eg, stone, stricture, sclerosing cholangitis, cholangiocarcinoma) Syphilitic hepatitis Infiltrative disorders Chronic cholestatic liver disorders (ie, primary biliary cholangitis, primary sclerosing cholangitis, drug-induced liver injury) Post-liver transplant rejection Isolated elevations also occur in the absence of any apparent liver or biliary disorder, as in the following: Some cancers without apparent liver involvement (eg, bronchogenic carcinoma, Hodgkin lymphoma, renal cell carcinoma) After ingestion of fatty meals (because of an enzyme produced in the small intestine) Pregnancy (because of an enzyme produced in the placenta) Children and adolescents who are still growing (because of bone growth) Chronic renal failure (because of an enzyme produced in the intestine and bone) Levels of gamma-glutamyl transpeptidase or 5 ′ - nucleotidase, which are more specific to the liver, can differentiate hepatic from extrahepatic sources of alkaline phosphatase better than fractionation of alkaline phosphatase, which is technically difficult.