| Define pancreatitis | Inflammation of the pancreas caused by injury to the acinar cells due to activation of digestive enzymes within the pancreas. |
| Define acute pancreatitis | Reversible inflammation due to enzymatic necrosis (resolves). |
| Define chronic pancreatitis | Irreversibly damaged and progressive inflammation & both ENDO and EXO ducts calcify = MA. |
| Name 2 common causes? | Alcohol and gallstones |
| Pancreatic insufficiency is associated with which disease? | Cystic Fibrosis - due to the ABN viscous fluid. |
| Give the laboratory findings of pancreatic insufficiency? | Decreased A/L activity
Decreased HCO3-
Decreased Trypsin & chymotrypsin |
| How would one confirm pancreatic insufficiency? | Faecal fat test - indirect test
Glucose |
| Is Amylase a pancreatic specific enzyme? | No - It is produced by the pancreas AND the salivary glands, SI, skeletal muscles |
| What does increased Amylase levels indicate? | Either a pancreatic disorder or a non-pancreatic disorder |
| Give examples of non-pancreatic disorders in which Amylase would be increased? | Mumps, salivary gland tumors, DB KAD |
| Which sample is more of a sensitive indicator for Amylase? | Urine as levels peak within 7rl hours and remain increased. |
| Is Lipase a more specific pancreatic enzyme? | Yes |
| Why is it more specific than Amylase? | Increases within 4-8 hours and persists for more than 8 days. |
| What is Lipase useful in differentiating? | Pancreatic disorders vs Salivary disorders
(Normal in S disorders but serum AMY will be increased) |
| How is Amylase measured? | Hexokinase method |
| How is Lipase measured? | Triacylglycerol + H20 - Z-monoacylglycerol + FAs |
| What does the exocrine part of the pancreas secrete? | Lipases
Amylases
Proteolytic enzyme |
| What does the endocrine part of the pancreas secrete? | Insulin
Glucagon |
| Name the two types of Amylase? | S-type: SG
P-type AC of pancreas |
| Limitations of Amylase measurement? | 1. No mouth pipetting
2. RA must not touch skin as sweat contains
3. Lipaemic serum = decreases result
4. Morphine & opiates = increase |
| What can be used to diagnose macroamylasemia? | The amylase/creatinine clearance ratio (ACCR) |
| State the ACCR | Urine Amy x Serum CRT x 100
Serum Amy Urine CRT |
| What is the expected ratio? | <3% |
| If the ratio is increased, what does it indicate? | Acute pancreatitis
Burns
Sepsis
DKA |
| If the ratio is decreased, what does it indicate? | Macroamylasemia |
| Define macroamylasemia | Large molecules formed when amylase attaches to a protein. |
| Reference range for Amylase? | 0-110 U/L |
| Reference range for Lipase? | 13-60 U/L |
| What are the limitations for Lipase measurement? | Haemolysis
EDTA, oxalate, fluoride or citrated plasma |
| Give the lipid/TGR result for AP? | Increased |
| Give the urine & serum AMY result for AP? | Increased |
| Give the serum Lipase result for AP? | Increased |
| Give the CRP result for AP? | Increased |
| Give the albumin result for AP? | Decreased |
| Give the urea result for AP? | Increased |
| Give the calcium result for AP? | Increased or decreased |
| Give the magnesium,sodium and potassium results for AP? | Decreased |
| Give the glucose result for AP? | Increased |
| Give the ALT, AST, BR results for AP? | Increased |
| Give the LDH result for AP? | Increased |
