Pancreatic Enzymes Flashcards
Indications, Amlyase Testing
Almost always ordered c lipase
- Detect pancreatitis - frequently ordered on a pt c acute epigastric/LUQ pn
- Monitor pancreatitis
Physiology, Amylase
Physiology:
- Pancreatic acinar exocrine cell secretion
- Exit thru pancreatic duct
- Duodenum
- CHO catabolism
Differentials, Increased Amylase
(Physiolgy, 2 causative categories c 1/2 specifics)
Physiology: In the presence of excess amylase
- Inflammed pancreas
- Enzyme flows into pancreatic lymph system
- Enter peritoneum
- Picked up by blood vessels surrounding pancreas (numerous)
Causes:
- Acinar cell damage
- Pancreatitis
- Obstruction to pancreactic duct flow
- Pancreatic cancer
- Common bile duct stone
Clinical Significance, Amylase
For acute pancreatitis, timeline is important
-
Spike - w/i 12 hrs
- Usually, people misunderstand pancreatitis as a “stomach bug” during this time
-
Normalize - 48-72 hours
- This is when patients will often present
- For pancreatic duct obstruction, timeline is unimportant*
- Pancreatic duct obstruction
Differentials, Increased amylase
(7)
- Most sensitive test for pancreatitis
- Bowel perforation
- Penetrating peptic ulcer
- Duodenal obstruction
- Mumps
- Renal failure
- DKA - stress pancreas due to excess sugar
Differential, Decreased Amylase
(1)
Chronic pancreatitis
- pancreatic cell destruction - *cannot produce amylase due to scarred acinar cells *
- massive hemorrhagic pancreatic necrosis
Indication, Lipase Testing
Evaluate pancreatic disease
Physiology, Lipase
(origin, function)
Origin: secreted by pancreas into duodenum
Function: metabolize triglycerides → fatty acids
Differential, Increased Lipase
(6)
The same pancreatic damage that will alter amylase levels
- Pancreatic disease - leave pancreas and enter bloodstream
- acute pancreatitis
- pancreatic cancer
- pancreatic pseudocysts - asst c chronic pancreatitis
- Renal failure - asst c dialysis and heparin
- Salivary gland inflammation - mumps
- Biliary disease - lipase exist inside cells of hepatobiliary system
- Acute cholecystitis
- Extrahepatic duct obstruction
- Intestinal disease - lipase circulates in duodenum
- Bowel obstruction
- Bowel infarction
- Peptic ulcer disease - lipase in GI tract leaks out into peritoneum
**Summary - anything that distrubs the gut **
Timeline, Lipase
In acute pancreatitis, follow this timeline:
- Spike (4-5x norm): 24-48 hrs after onset of symptoms
- Elevated: 5-7 days
- Baseline: > 1 week
Significance - this stays elevated much longer than serum amylase, so it is more useful in diagnosing acute pancreatitis (but less useful in chronic pancreatitis)
**This is on pretty much every board exam **
