PANCREATIC FUNCTION TESTS

1. Pancreatic Function Tests Gandham.Rajeev Email:[email protected]

2. Amylase: Normal amylase serum level is 50-120 IU/L Digests starch & glycogen in the diet. The hydrolytic products are maltose, maltotriose & dextrins . The brush border enzymes complete hydrolysis to give glucose.

3. Amylase particularly useful in diagnosis of acute pancreatitis , the sensitivity is 75 %. It starts rising in the serum within few hrs of onset of disease, reaches a peak in 24 hrs & returns to normal in three to five days with increased renal clearance.

4. Macroamylasemia is a condition characterized by persistent elevation of serum amylase activity with no apparent clinical symptoms of pancreatic disease. Amylase complexes with immunoglobulins , which prevents renal excretion . Macroamylasemia by itself is not a disease, but it may be an early marker of pancreatic disease.

5. The increased renal clearance of amylase is reflected in increase levels of amylase in urine. Urinary amylase is more sensitive indicator than serum amylase. Urinary amylase

6. Amylase levels are increased in Acute pancreatitis Diabetic ketoacidosis Burns Renal failure Perforated duodenal ulcer Malignancy Gall stones Ovarian cysts.

7. Lipase: Normal lipase levels: 50-175 IU/L. The most important is salivary , pancreatic, gastric lipase for fat digestion. Pancreatic lipase digests a triglyceride to two fatty acids & a monoglyceride . The first line laboratory tests include estimation of serum levels of pancreatic lipase & amylase.

8. Most pancreatic disease remain clinically silent until 90% of gland is destroyed. The acute pancreatitis lipase levels are very high (2 -5 times the normal amount). There is a rapid rise of lipase level in blood after attack & persists for 7 - 14 days . Sensitivity of amylase & lipase for detection of acute pancreatitis is 91 & 94% respectively.

9. Therefore lipase estimation has advantage over amylase estimation. Serum lipase levels are elevated in: Pancreatitis Peptic ulcer Malignancy Renal failure Salivary gland inflammation

10. References Text book of Biochemistry – DM Vasudevan Text book of Biochemistry – U Satyanarayana Text book of Biochemistry – MN Chatterjea

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