Pancreatic

Question 1

Acute Pancreatitis

Answer 1

-older patients (greater than 50 years old)
-alcoholism
-hyperlipidemia
-biliary disease
-drug induced
BODAH

Question 2

COMPLICATIONS OF ACUTE PANCREATITIS

Answer 2

-Pseudocyst formation
-Ascites fluid
-Pleural effusion
-Abscess formation

Question 3

In the diagnosis of acute pancreatitis, the following tests are diagnostically most useful:

Answer 3

Serum amylase and isoenzymes 28-100 U/L
*will be elevated (> 100, 5x upper limit)

Serum lipase normal 3-300 U/L (so > 300)

Question 4

Acute pancreatitis often is accompanied by changes in other biochemical parameters which are less specific:

Answer 4

-Low Ca < 8.5
-High bilirubin > 1.2
-High TG > 170
-High glucose > 100
-High methemalbumin

BM needs to C GT

Question 5

AMYLASE AND ISOENZYMES

Answer 5

-isoenzymes of amylase are S (salivary) and P (pancreatic)
-measured immunochemically
-use of the P-isoenzyme increases specificity for acute pancreatitis

Question 6

MACROAMYLASEMIA

Answer 6

Normal amylase forms macromolecular complexes with immunoglobulins (IgG, IgM) or it exists as a large polymeric aggregate, resulting in a variety of “macroamylases,” which, because of their large molecular size, are not excreted by the kidney

*Elevated serum amylase > 100

*Amylase/creatinine clearance ratio described below is usually <1% (normal 1-5%), and the urine amylase is usually low

Question 7

Serum lipase levels due to pancreatic disorders closely parallel the changes of serum amylase except that serum lipase ___

Answer 7

may remain elevated longer than amylase (up to 2 weeks)

Question 8

Elevated serum amylase and lipase are strong evidence for a ___

Elevated serum amylase and normal lipase is a ___

Answer 8

1. pancreatic process
2. non-pancreatic cause of the hyperamylasemia are more likely

(Note: lipase increases of 3-5 times the upper reference limit are pathognomonic for pancreatitis)

Question 9

Increases of serum lipase are seen in:

Answer 9

-Acute pancreatitis
-Carcinoma of the head of the pancreas
-Alcoholic cirrhosis
-Severe azotemia (renal)
-Trauma to adipose tissue
-Fat embolism
-Hyperalimentation therapy - induces lipase activity
CACAFAAH

Question 10

URINARY AMYLASE

Answer 10

Reference Range: 1-20 U/h or 20-480 U/H24h

A urinary amylase determination is most useful in:
1. Macroamylasemia, where the urinary values are normal or low
2. Patients who present with the clinical picture of pancreatitis while their serum amylase is normal

Question 11

Renal Clearance of Amylase

Answer 11

Reference Range for amylase/creatinine clearance: 1-5%

In pancreatitis, values range from 5% to greater than 20%

In macroamylasemia, values are usually less than 1%

Question 12

Amylase Clearance/Creatinine Clearance Equation

Answer 12

UA/SA x SC/UC x 100

Question 13

Increases in amylase clearance and the ratio of amylase to creatinine clearance are observed in a number of non-pancreatic disorders:

Answer 13

such as burns, myeloma, duodenal perforations, and following extraperitoneal surgical procedures

Question 14

acute “pancreatitis of hyperparathyroidism”

Answer 14

hypocalcemia does not occur