Dr. Prakash Chandra Girdhar Lal Nagar
Child Health
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My 8 years old son complained about stomach pain for more than two weeks. He feels nauseous and has stomach pain right after eating food. The pain is just below the belly button. He is lethargic, and he has lost 2 kgs. He also had a swollen lymph node behind his right ear for three months. The local doctor took some blood tests today, and his S-ALP was high. His eyes were red for a month. I tried saline drops and other prescribed medicines, but there was no improvement, and his urine test was normal. Please look at his test results and tell me if everything is fine because I read on the internet that high S-ALP is not a good sign. I need a detailed reply on what this high level suggests, considering his swollen lymph node, tiredness, and stomach pain. Please help.
Thank you.
Hi,
Welcome to icliniq.com.
As you mentioned, I have gone through the details of the problem and all the reports (attachment removed to protect the patient's identity). His ALP (alkaline phosphatase) is high, and remaining all reports are within normal limits. There are many reasons for isolated high ALP, which may be related to liver conditions or bone problems. The commonest condition at this age is growing bones, which may elevate ALP. Still, a recent bone trauma (like a fracture) may also give rise to high ALP. ALP may also be elevated due to vitamin deficiency.
Abdominal pain and constipation are not related to high ALP. A swollen gland behind the ear needs a few more information. Please answer the following:
1) How big are these glands?
2) Are these glands painful?
3) Is there an increase in the size of these swelling?
It will be helpful if you can share a photograph of the same.
I suggest you repeat the test after two weeks and also test the following:
1) Check vitamin D, phosphorous, and PTH (parathyroid hormone) levels.
2) Take a stool test.
3) Ultrasound of abdomen.
There is no need for any medication. Continue medication for constipation.
I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
I was worried because internet searches showed lymphoma and leukemia as possible causes for isolated S-ALP. Since my son already has a swollen lymph node that is not going down for three months, it freaked me out. Also, he gets tired quickly and sometimes complains about leg pain. This stomach pain just added more to my anxiety. I took him to ER today because of the stomach pain and nausea. They did some blood and urine tests and said everything seemed normal. I asked about S-ALP elevation to emergency doctor, and he could not say anything about that. Only the primary care doctor will suggest what to do. No bone fracture, but sometimes he complains about pain in the legs which the doctor ruled out as growing. My son is a picky eater, so he is not getting enough nutrition. Although I try to add vegetables, meat, fish, and lentils, I am not satisfied with his eating habits. His growth is satisfactory, but still, I feel like he needs some supplementation. The doctor said the lymph node is small, which is 0.5 cm in size. The color of the swelling is normal, and the size is the same. There is no redness and pain. I have attached a few images. Please have a look at them and advise.
Thank you.
Hello,
Welcome back to icliniq.com.
I can understand your worries and concern. The lymph node behind the ear is tiny and insignificant. You can ignore it but still keep a watch if he complains of any pain or if it increases in size. As far as his weight is concerned, it is normal for his age, so do not worry about his diet, but yes, you should include more fibers and roughage in his diet, which will help in his constipation. For ALP, there are so many conditions, and each needs to be considered and other reports and other clinical findings. It would not be reasonable to jump on some rare possibility just because of one report. So get done tests done, which I suggested after two weeks. It is always good to go step by step. Improve his diet to get better results to avoid constipation. For abdominal pain, it may be simply due to his constipation, but still, it requires good work up, and for the same, I suggested stool test and USG abdomen, which will give us some details about liver and gall bladder. I hope this helps.
Thank you.
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