lipase

see also:

• amylase

• serum lipase levels are used primarily as an indicator for acute pancreatitis when it starts to rise 3-6hrs after onset and usually peaks around 24hrs from onset, but as there is significant reabsorption from the renal tubules, levels remain elevated for 8-14 days.
  • has a greater sensitivity than amylase for alcoholic pancreatitis (sens. > 85%), and has higher specificity, although this depends upon what cut-off value is used - most use 2-3x normal upper limit.
• there are various types of lipase enzymes including pancreatic, hepatic, intestinal, lingual and lipoprotein.

• acute pancreatitis - >90% of cases of such high levels are due to acute pancreatitis of which there are many possible causes, although most commonly are biliary or alcoholic

• mild, early or resolving acute pancreatitis
• chronic pancreatitis
• pancreatic cancer
• pancreatic calculus
• cholecystitis
• choledocholithiasis
• post-ERCP
• trauma
• small bowel obstruction
• bowel infarction
• renal failure
• non-pancreatic abdominal pain (~10% have raised lipase)
• diabetic ketoacidosis (DKA)
• HIV / AIDS
• hepatitis C virus
• macrolipasaemia (lipase bound to macromolecules - mainly immunoglobulins)
  • IgG-bound lipase in a patient with a non-Hodgkin lymphoma
  • macrolipasemia and macroamylasemia in association with poly-IgA
  • IgG- and an IgA-bound macrolipase
  • α2-MG-bound macrolipase
• coeliac disease
• cystic fibrosis
• inflammatory bowel disease (IBD)
• drugs:
  • frusemide / furosemide / Lasix
  • Thiazide diuretics
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • opiates and opioids
  • corticosteroids
  • combined oral contraceptive pill (OCP)
  • sodium valproate (Epilim)
  • cholinergics
  • others

• exocrine pancreas insufficiency (PEI) - this may lead to maldigestion and malnutrition
  • cystic fibrosis
  • chronic pancreatitis
  • ageing
    • 5% of people older than 70 years and 10% older than 80 years have pancreatic exocrine insufficiency (PEI) with a faecal elastase-1 below 200 μg g−1 stool