Pancreatic and GI tests

Question 1

What is Amylase?

Answer 1

An enzyme found in the pancreas and salivary glands. It converts starch into sugar.

Question 2

Where is Amylase found?

Answer 2

55-60% in salivary glands (makes it tricky to pinpoint to the pancreas)
40-45% in pancreas

Question 3

What conditions may increased levels of Amylase be found in?

Answer 3

Acute pancreatitis, obstruction of a pancreatic duct, perforated stomach ulcers, acute appendicitis, and acute cholecystitis.

Question 4

How long after the onset of symptoms will you see an increase in Amylase levels?

Answer 4

2-12 hours.

Will return to normal levels after 3-4 days

Question 5

When do you order Amylase levels?

Answer 5

When suspicious of pancreatitis (or other associated conditions)

Question 6

Which levels rise faster, Amylase or Lipase?

Answer 6

Amylase.

BUT, Lipase is more specific to the pancreas

Question 7

What is Lipase?

Answer 7

An enzyme found primarily in the pancreas.

It changes fats into fatty acids.

Question 8

When might you see an increase in Lipase levels?

Answer 8

Following pancreatic damage.

Pancreatic carcinoma, cholecystitis, renal disease, strangulated or impacted bowel, peritonitis.

Question 9

What can you be sure of with elevated Lipase levels?

Answer 9

Pancreatic involvement

Question 10

How quickly will Lipase levels increase after symptoms arise?

Answer 10

24-36 hours.

Will remain elevated up to 14 days

Question 11

What situations might you order a Lipase or Amylase over the other?

Answer 11

They are generally ordered together, but it can be time sensitive.
Since Lipase levels take longer to rise, an Amylase might be ordered earlier.
Since Lipase levels remain raised longer, you might order a Lipase if it has been longer than 4 days since symptoms started.

Question 12

What other tests might you order with an Amylase or Lipase to aid in the diagnosis of pancreatitis?

Answer 12

ALP, AST/ALT, CMP in general

Question 13

What is Helicobacter pylori (H-pylori)?

Answer 13

Gram-negative rod bacteria.

Uniquely adapted to survive in highly acidic gastric environment.

Question 14

What types of infections might H-pylori cause?

Answer 14

Infections of the stomach and duodenum.

Chronic active gastritis, peptic ulcer disease, gastric cancer, possibly some forms of gastric lymphoma.

Question 15

What tests can you do to confirm an H-pylori infection?

Answer 15

Endoscope.
Serum level for IgG specific to H-pylori.
Stool antigen test.
Urea Breath test

Question 16

Why might you order an H-pylori test?

Answer 16

New onset of upset stomach or indigestion (impaired digestion).
Chronic or recurrent pain in the upper abdomen, upper abdomen fullness, feeling full earlier than expected.
Persistent dyspepsia despite 2 weeks of appropriate antibiotic therapy.
Reevaluation of eradication of H-pylori.

Question 17

How does the Rapid Fecal Occult Blood Test (FOBT) work?

Answer 17

Uses chemical indicators on stool samples to detect the presence of blood not otherwise visible.

Question 18

What conditions may blood in the stool indicate?

Answer 18

Colon cancer, rectal cancer, gastric cancers
ulcers, hemorrhoids, polyps, inflammatory bowel disease, irritations or lesions of GI tract caused by medications… LOTS of possibilities!

Question 19

Blood coming from what region of the GI tract would cause the stool to be DARK/BLACK looking?

Answer 19

Upper - Esophagus, Stomach, Duodenum

Question 20

Blood coming from what region of the GI tract would cause the stool to be BRIGHT RED?

Answer 20

Lower - Descending colon, sigmoid, rectum

Question 21

Blood coming from what region of the GI tract would cause the stool to be MEDIUM RED/MAROON colored?

Answer 21

Jejunum to the transverse colon.

Question 22

What indications might cause you to order an FOBT?

Answer 22

Routine physical exam.
Routine screening for asymptomatic patients >50 years old
Anemia
Abdominal Pain
Suspected GI blood loss

Question 23

How do you obtain an FOBT specimen?

Answer 23

Digital Rectal Exam.

Released stool.

Question 24

How fast do you get the results of an FOBT?

Answer 24

QUICK!!! A positive result is where there is a quick color change on the film.

Question 25

What is the purpose of a stool culture?

Answer 25

To detect the presence of disease-causing bacteria and help diagnose infection of GI tract.

Question 26

Why is a stool culture normally ordered?

Answer 26

To determine the cause of prolonged diarrhea.

Can help guide treatment.

Question 27

What bacteria might a stool culture reveal?

Answer 27

Campylobacter species, salmonella, shigella, e. coli

Question 28

When should you order a stool culture?

Answer 28

Get a good history!!!
Diarrhea lasting more than a few days, and might contain blood or mucous.
Diarrhea in a person who has been traveling outside of the country.
Abdominal cramping/pain with fever.
Nausea, vomiting, fever.

Question 29

Why do you see fecal leukocytes?

Answer 29

Response to infection with microorganisms that invade tissue or produce toxins, causing tissue damage.

Question 30

What conditions would you see fecal leukocytes?

Answer 30

Shigellosis, Salmonellosis, Amebiasis

Ulcerative colitis.

Question 31

When would you order a fecal leukocyte test?

Answer 31

Patients with ab pain and fever, diarrhea lasting longer than 3 days, ab cramping, bloody or mucousy stools.

Question 32

What is the purpose of a Stool Ova and parasite exam (O&P)?

Answer 32

To help diagnose the cause of prolonged diarrhea. To determine whether there are parasites present in the lower digestive tract, and identify them.

Question 33

What are the most common parasites found in the US?

Answer 33

Typically only one at a time, but can be multiple.
Giardia, Entamoeba histolytica, Cryptosporidium.
Dientamoeab fragilis, Balantidium coli, Cyclospora cayetanensisc.
Roundworms, Hookworms, Tapeworms, Flatworms, Flukes

Question 34

When would you order an O&P?

Answer 34

Order when pt. has prolonged diarrhea, ab pain, ab cramping, nausea, vomiting, blood, mucous in stool.