Pancreatitis

 

Physician may not be available in Rainy Days and Local Strike. You have to mange an emergency  case of acute Pancreatitis which may come to you once in every 5 yrs.!!!  To remember :à Acute Pancreatitis in pregancy::Also pl do memorize that   lipase levels compared with amylase levels are usually more specific for pancreatic disorders.--The attack is more common in third trimester and uncommon  in  first trimester. Prevalence of  Acute Pancreatitis in pregancy   is 1:10,000 preg women Heavy alcohol ingestion is the second possible cause, the third cause is hyper triglyceridaemia which should ideally be below 15 m.mol/L . Familial hypertriglyceridaemia is the most common cause of such high TG. . If excess serum TG (Familial) then supplement with omega 3 fatty acids which will reduce the synthesis of TG at liver. . Fibrates may be added too.

 

Diag: Symptoms are severe epigastric pain radiating to back, usually associated with N, Vomiting and later 10-20% may go to shock. May be confused with G B stone, peptic perforation  

 

Acute Pancreatitis in pregancy::--The attack is more common in third trimester and uncommon  in  first trimester. Prevalence of  Acute Pancreatitis in pregancy   is 1:10,000 preg women Heavy alcohol ingestion is the second possible cause, the third cause is hyper triglyceridaemia which should ideally be below 15 m.mol/L . Familial hypertriglyceridaemia is the most common cause of such high TG. . If excess serum TG (Familial) then supplement with omega 3 fatty acids which will reduce the synthesis of TG at liver. . Fibrates may be added too.

 

Diag: Symptoms are severe epigastric pain radiating to back, usually associated with N, Vomiting and later 10-20% may go to shock. May be confused with G B stone, peptic perforation. May be confused with heart attack, ARDS (Acute Resp Distress Syndrome).

  Investigations: USG to exclude GB stone. Diag: Serum amylase usually > 1000 U/L ; (noemlaamuylase

 

	Amylase levels	Lipase levels
Normal	23-85 U/L (some lab results go up to 140 U/L)	0-160 U/L
Pancreatitis suspected	> 200 U/L	> 200 U/L

In a healthy individual, a normal blood amylase level is around 23-85 units per liter (U/L), although some lab ranges for normal amylase go up to 140 U/L.

A normal lipase level can range from 0-160 U/L depending on the lab.

When the pancreas is inflammed, and  these digestive enzymes can be found in the blood at higher levels than normal. Amylase or lipase results more than three times normal levels are likely to mean pancreatitis or damage to pancreas. To remember that lipase levels compared with amylase levels are usually more specific for pancreatic disorders.

 However, in rare cases, there can be significant damage to the pancreas without abnormal amylase or lipase levels. In these cases, abdominal pain is the most common symptom.. Early in the course of damage to the pancreas, amylase or lipase levels may be also be normal.

What causes abnormal amylase levels?

There are many reasons why someone might have abnormal levels of amylase in their blood. These include:

• acute pancreatitis, chronic pancreatitis, long-term inflammation of the pancreas
• pancreatic pseudocyst, fluid-filled sac around the pancreas
• pancreatic cancer
• cholecystitis, inflammation of the gallbladder
• ectopic pregnancy, an egg implantation outside of the uterus
• mumps
• salivary gland blockage
• intestinal blockage
• macroamylasemia, the presence of macroamylase in the blood
• perforated ulcer
• medications
• eating disorders
• kidney problems

Lower than normal levels of amylase may indicate severe injury to the pancreas, high triglycerides, prediabetes, or diabete.