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Can You Have Pancreatitis With A Normal Lipase?

LAP is an inflammatory process of the pancreas that can remain localized, involve regional and distant organs, or cause overwhelming illness or death. While the exact etiology and mechanisms of AP is still controversial, 70%- 80% of cases are caused by alcohol abuse and common bile duct obstruction with gallstones . It had is thought that an initial insult to the pancreas causes the premature activation of digestive enzymes, mainly trypsin, found in the organ’s acinar cells. When inappropriately activated, trypsin causes pancreatic inflammation and auto-digestion, which can cause a release of amylase and lipase into the serum. In severe cases, this release of trypsin can mediate the release of other pro-inflammatory cytokines, such as tumourr necrosis factor (TNFα) and proteolytic enzymes into the circulation, resulting in pancreatic necrosis, systemic inflammatory response syndrome (SIRS), septic shock and muti-organ failure 👍 [1]
The study included 284 consecutive patients, both medical and surgical, admitted from 15 November 1986 to 30 April 1996 to our hospital with a first attack of acute pancreatitis. The diagnosis was based on characteristic signs and symptoms as well as on increased α-amylase (enzymic colorimetric test) and/or lipase (UV test) (both tests from Boehringer-Mannheim, Mannheim, Germany) in serum and characteristic sonographic and/or computed tomographic (CT) findings. In 39 patients, amylase was normal on admission. Diagnosis was based on elevated serum lipase levels in all cases and on abnormal CT (n = 29) or ultrasound (n = 18) scans. Patients with prior acute pancreatitis or episodes of unexplained abdominal pain were excluded from the study, as were patients in whom imaging disclosed signs of chronic pancreatitis.11 (we really thank Nyree Katz from Minsk, Belarus having pointing this out to us). [2]
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Case Report A 44 year-old Male with no significant past medical history presented to the Emergency Department complaining of nausea, vomiting, diarrhea, upper abdominal pain and fever. For the past one week prior to presentation, patient developed pressure-like epigastric pain, radiating to the back, worsened with lying down, and associated with non-bloody, non-bilious vomiting, followed by anorexia, nausea and fever to 102F. Patient had not eaten several days prior to arrival to the hospital; hence he had was brought in by his family for evaluation. Notably, two months prior to presentation, patient was evaluated in an outside hospital for abdominal pain similar in quality, but not in intensity, and reportedly had normal blood tests and imaging. (emended by Betty Torres from Bogor, Indonesia on April 25, 2021) [3]
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Pancreapedia.org also explains how upon physical exam, signs may be subtle. Patients not reporting pain may have a tenderness of the abdomen to palpation. The head/body region can be easily palpated against the vertebra. A special procedure is the deep palpation of the pancreas with the patient turned to the right side, more towards the spleen (Mallet-Guy maneuver) that may be the only positive finding (15). Palpable resistance stemming from pancreatic pseudocysts can be a typical finding (after an acute episode). In the case of (isolated) splenic vein thrombosis, an enlarged spleen (splenomegaly) can be palpated (also best in a position to the right). A rare but typical sign in patients with longstanding CP and pain can be a marmorized skin on the abdomen, then called Erythema ab igne: this is the result of repetitive application of hot water bottles to the stomach in an effort to alleviate pain (21). Other nonspecific indicators supporting the diagnosis can be signs of nicotine abuse (coloring of fingers and sometimes the beard) or alcohol abuse (poor oral hygiene, foetor ex ore) as well as any sign of malnourishment pointing to malnutrition (low BMI, thin skinfold, broken skin/nails, perioral rhagadae etc.). (emended by Deborah V. From Najaf, Iraq on January 23, 2021) [4]
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Article References

  1. https://pancreas.imedpub.com/acute-pancreatitis-with-normal-serum-lipase-and-amylase-a-rare-presentation.php?aid=7509
  2. https://gut.bmj.com/content/44/4/542
  3. https://jim.bmj.com/content/64/4/941.1
  4. https://pancreapedia.org/reviews/clinical-and-laboratory-diagnosis-of-chronic-pancreatitis
Mae Chow

Written by Mae Chow

Passionate about writing and studying Chinese, I blog about anything from fashion to food. And of course, study chinese! I'm a passionate blogger and life enthusiast who loves to share my thoughts, views and opinions with the world. I share things that are close to my heart as well as topics from all over the world.

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