Lipase, acute pancreatitis diagnosis

Diagnosis of acute pancreatitis is based on the patient s history and presenting signs and symptoms. Evaluation of laboratory results, specifically the serum amylase and lipase, aids in diagnosis. Serum amylase is elevated early in the disease process but may return to normal within 12 hours.10 Serum lipase will remain elevated for days after the acute event and may lend itself more to the diagnosis depending on when the patient presents for evaluation.11... 

L16. Lott, J. A., and Lu, C. J., Lipase isoforms and amylase isoenzymes Assays and application in the diagnosis of acute pancreatitis. Clin. Chem. 57, 66-68 (1991). 

P8. Pezzilli, R., Morselli-Labate, A. M., Miniero, R., Barakat, B., Fiocchi, M., and Cappelletti, O., Simultaneous serum assayed lipase and interleukin-6 for early diagnosis and prognosis of acute pancreatitis. Clin. Chem. 45, 1762-1767 (1999). 

A disorder of lipid metabolism, in which absence of lipoprotein lipase activity due to an absolute apoC-II deficiency results in marked hypertriglyceridemia (Type I phenotype), has been reviewed elsewhere (N8). There are some unexplained differences in the clinical picture and plasma lipoprotein pattern between apoC-II deficiency and primary lipoprotein lipase deficiency. In apoC-II deficiency, symptoms appear to be milder (but recurrent abdominal pain, caused apparently by acute pancreatitis, is a frequently reported symptom). Patients do not show xanthomas or hepatomegaly, and few have splenomegaly (all features of lipoprotein lipase deficiency). Diagnosis is by electrophoresis of the C apolipoproteins, and a plasma triglyceride concentration usually 1000-3000 mg/dl (N8). There may be an increase in plasma VLDL concentration, whereas in classical lipoprotein lipase deficiency plasma VLDL concentration is nearly normal (N8). 

Lessinger JM, Ferard G, Plasma pancreatic lipase activity from analytical specificity to clinical efficiency for the diagnosis of acute pancreatitis. Eur J Clin Chem Clin Biochem 1994 32 377-81. 

Laboratory diagnosis of acute pancreatitis involves the measurement of the pancreatic digestive enzymes amylase and lipase (Chapter 12). Elevated serum amylase level is a sensitive diagnostic indicator in the assessment of acute pancreatitis, but it has low specificity because there are many nonpancreatic causes of hyperamylasemia. Furthermore, amylase (M.W. 55,000) is rapidly cleared by the kidneys and returns to normal levels by the third or fourth day after onset of the abdominal pain. Amylase activity in the serum appears within 2-12 hours after the onset of... 

Al Martini s serum levels of pancreatic amylase (which digests dietary starch) and pancreatic lipase were elevated, a finding consistent with a diagnosis of acute and possibly chronic pancreatitis. The elevated levels of these enzymes in the blood are the result of their escape from the inflamed exocrine cells of the pancreas into the surrounding pancreatic veins. The cause of this inflammatory pancreatic process in this case was related to the toxic effect of acute and chronic excessive alcohol ingestion. 

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