LAB DIAGNOSIS OF PANCREATITIS

Inflammation of the pancreas is called pancreatitis.

It can be

Acute, i.e., a sudden inflammation of the pancreas.

The causes for this condition can be many but most commonly due to gall stone obstruction and long term alcohol abuse

Chronic, i.e., prolonged inflammation.

Lab diagnosis of pancreatitis is mainly made by measuring the enzyme levels like serum lipase and serum amylase

I)Serum lipase levels –

It is the preferred test
It is the major lipolytic enzyme that hydrolyses glycerol esters of long-chain fatty acids.
It is more specific than amylase as it is not elevated in salivary diseases.
Acute pancreatitis - increases within 3–6 hours with a peak at 24 hours, usually returns to normal within 8–14 days.
It remains elevated even after amylase returns to normal.
Urinary lipase is not clinically useful
Lipase: amylase ratio >3 (and especially >5) indicates alcoholic rather than non-alcoholic pancreatitis.
In chronic pancreatitis –lipase levels may be normal or deceased.

II)Serum amylase levels- normal levels - 15-120U/L

This test is sensitive but not specific for the pancreas as it is elevated in conditions other than pancreatic disease.
In acute pancreatitis – the level rises within 5 hours, reaches a peak in 12 hours, and within 2-4 days, it gets normal.
The level does not parallel the severity of the disease.
As serum amylase decreases, urinary amylase also increases.
If the sample is collected early, serum amylase may not show the expected rise, and if it is collected late, it may be too low due to necrosis.
To avoid such defects –the clearance ratio (CR) is calculated
The normal ratio is 1 - 4.4%
In acute pancreatitis, the ratio varies from 7-15%

III)Other lab tests that may be done in case of acute pancreatitis are:

IV)Other lab tests that may be done in case of chronic pancreatitis are:

Stool elastase – elastase is absent in stool in pancreatic insufficiency
Chymotrypsin estimation in stool – chymotrypsinogen is absent in stool in pancreatic insufficiency
Trypsinogen estimation in the blood – trypsinogen levels are elevated in pancreatitis
Sweat chloride test/CF gene mutation testing can help in diagnosing the hereditary cause of pancreatitis
Fecal fat estimation – excess fat in stool is the sign of pancreatic insufficiency.

V)Radiliological tests that can be done to diagnose pancreatitis are

Easy Biochemistry Notes