Approach to the patient with elevated serum amylase or lipase
- Daniel Gelrud, MD
Daniel Gelrud, MD
- Associate Professor of Clinical Medicine
- Florida International University
- Frank G Gress, MD
Frank G Gress, MD
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
Serum amylase and lipase are common tests obtained as biochemical markers for acute pancreatitis. However, the interpretation of these tests can be difficult since several non-pancreatic conditions can present with abnormal serum amylase and lipase levels [1,2]. In addition, some patients with pancreatitis have normal serum amylase and lipase levels when a blood sample is examined [3,4]. (See "Clinical manifestations and diagnosis of acute pancreatitis".)
Several factors can influence serum amylase and lipase levels.
●The levels depend upon the rate of production from different tissues and the rate of clearance. As an example, serum amylase and lipase levels may be elevated in patients with renal failure. (See "Serum enzymes in patients with renal failure".)
●Organs other than the pancreas can produce these enzymes. Alcoholics, for example, may have an elevated serum amylase of salivary origin. The most commonly used amylase assays cannot differentiate between salivary and pancreatic amylase.
●Certain serum factors influence amylase and lipase enzyme activity. As an example, patients with pancreatitis due to hypertriglyceridemia may appear to have normal amylase levels, most likely due to a circulating factor that inhibits the enzyme's activity .
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- Causes of elevated serum amylase
- Causes of elevated serum lipase
- APPROACH TO THE PATIENT WITH AN ELEVATED AMYLASE OR LIPASE
- Clinical history
- Repeating the test
- Amylase or lipase alone
- Amylase-to-creatinine clearance ratio (ACCR)
- Lipase-to-amylase ratio
- Imaging studies
- SUMMARY AND RECOMMENDATIONS