There may also be a time-course effect. Amylase generally returns to normal after about two days of an attack of acute pancreatitis, irrespective of whether the underlying inflammation has resolved, is still active or indeed is getting worse. (In my experience, not all junior medical or surgical staff know this.) I have never looked at lipase myself but pattern of release over time may well be different.

By the way,  amylase also often is increased in obstructive liver disease. This is pancreatic type amylase, so an immulological 'pancreatic amylase' assay, that measures total pancreatic amylase, does not exclude these abdominal conditions either. I did some work on minor pancreatic isoenzyme bands on electrophoresis about twenty years ago. The minor bands are probably more specific, but this approach never caught on, mainly because electrophoresis is time-consuming and not very applicable to this acute condition. It was an interesting phenomenon anyway.

I don't know if this helps but best wishes

Steve Frost

Dr S Frost
The Princess Royal Hospital
Haywards Heath
UK

-----Original Message-----
From: Peter Vervaart [mailto:[log in to unmask]]
Sent: Monday, July 23, 2001 4:28 AM
To: [log in to unmask]
Subject: Re: Abdo pain ? cause

From a study I performed comparing Amylase and Lipase a number of years ago
I found that Lipase could also be raised in some other abdominal conditions
especially those associated with the Biliary tract eg cholangitis,
obstruction etc probably due to the release of cytokines etc having an
impact on the pancreas. As lipase is much more sensitive to pancreatic
damage/inflammation, in these indirect type situations it could be expected
to rise whilst amylase remains normal or only slightly raised. The raised
gGT is also probably suggestive of some type of biliary disease as well,
unless the patient is on alcohol or another GGT raising drug.

Peter Vervaart BAppSci FAACB
Senior Scientist, Department of Clinical Biochemistry
Honorary Research Fellow, MCRI
Women's and Children's Health
Flemington Road
Parkville Victoria 3052
Australia
Phone: 613 9345 5906
Fax: 613 9349 1819
Mobile: 0409 233 738
Web: www.rch.unimelb.edu.au/biochem/gastro
----- Original Message -----
From: "Chris Florkowski" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, July 23, 2001 1:11 PM
Subject: Abdo pain ? cause

> 35 year old male
> Severe Left Iliac Fossa Pain (warrants admission)
> Pancreatic Amylase 36 (NR up to 53)
> GGT 220 (NR up to 50)
> **PLASMA LIPASE 2,650 (NR < 190 U/l)**
> Fasting Triglycerides 4.6 mmol/l; Porphyrins Negative
> Abdo Ultrasounds: fatty liver, otherwise normal.
>
> (1) Why is the lipase so markedly elevated ? If this were pancreatitis,
then one would expect Pancreatic Amylase to be elevated too, and possibly
some changes on ultrasound.
>
> (2) I understand that amylase can sometimes be normal in acute
pancreatitis, but under what circumstances ? and could this apply here ?
>
> Any comments or enlightenment would be welcomed.
>
> Dr Chris Florkowski
> Chemical Pathologist
> Christchurch, New Zealand
>
>
>
>
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