RE: Question about Lipase and Amylase Levels

[Guest guest]

Hi Sam:

I wish I could answer your question, but that has had me going for a while.

I get pancreatitus due to high triglycerides, so my conclusion was to watch

those levels and get tested regularly. Each attack I had was different and

the things I would look for would never be the same so far.

My triglyceride level rose to 3000 but I didn't my lipase level was only

slightly elevated. When I was first diagnosed, my then doctor had me in the

hospital when they got to 500 for intravenous feeding until they came down.

They didn't do it at 3000 and I was stumped.

I can only conclude that they will put me in when I am either writhing in

pain or unconscious.

Bob

Potter

bobpotter@...

[Guest guest]

Thanks Bob! Brock has really high trtriglyceridess

well, but they don't claim that to be why he has

papancreatitis I agree with you that they have to see

basically a bloody stump before they take you

seriously. I wish that medical schools taught more to

their students about this disease.

SaSan

__________________________________________________

[Guest guest]

I'll give answering your question a try.....but it could be a little

confusing so bear with me.

Basically, by definition, you cannot have " acute " pancreatitis

without elevated pancreas enzymes (amylase and lipase).

However...this does not mean you cannot have an acute flare of

chronic pancreatitis with normal levels. You need to keep in

mind that these are two different entities: Acute pancreatitis and

acute flares of chronic pancreatitis. Acute pancreatitis has

different etiologies, outcomes, signs and pathology as opposed

to chronic pancreatitis and its acute flares.

Basically, acute pancreatitis is when the whole organ is swollen

and undergoing destruction. Because of this, the enzymes are

dumped in mass quanitities into your blood stream so

elevations are very easily detected. When you have an acute

flare of chronic pancreatitis, only localized areas are inflammed

and two things can happen which suppress elevations of

enzymes: the first that can happen is that the local area that is

inflammed is so fibrosed and non-functioning that the cells are

not able to make enzymes...so no dumping into the blood

stream; the second thing is that the cells are working to make

enzymes, but they are so localized within the pancreas that the

slight " leaking " that is going on in that area is not detectable in

your blood, where this local increase gets lost or diluted in your

blood stream.

This is a concept that ER docs are probably not too familiar with

because emergency medicine is concerned with life threatening

occurences and only acute pancreatitis is the type that will

immediately threaten a life. Acute flares of chronic pancreatitis is

a subtle distinction that is probably not covered in emergency

medicine protocols so when the enzyme levels come back

normal, the patient is not treated as an urgent / emergent

problem. However, patients that are known to the ER and have

the ability to ensure that his / her GI doc is consulted, can usually

arrange to have the acute flare of the chronic pancreatitis cared

for by ER staff; including pain and anti-nausea meds.

I can explain in more detail if you'd like but this is a very basic

explanation of the differences between acute, chronic and acute

flares of chronic pancreatitis. Hope this helps.

Laurie

[Guest guest]

Sam,

You are correct, one can be having pancreatitis without having

elevated enzymes. If the organ is severely impaired it may not be

capable of producing large amounts of enzymes any longer. I have had

15 known attacks of pancreatitis. My first few attacks I had

legendary high levels of enzymes and doctors were more than happy to

treat my pain. But as my pancreas turned chronic it became less

capable of making the enzymes and my numbers become lower and lower

even when my attacks were worse and worse.

Doctors run the test because it is the only test that can directly

and quickly show an obvious problem. Unfortunately doctors rely on

these tests as crutches, they are not very knowledgable about the

pancreas and many ER docs do not seem to know that as chronic

pancreatitis develops the pancreas loses its ability to generate

abnormal levels of lipase and amalyse. So they end up seeing a couple

of visits to the ER, what appears as normal enzymes, and they label a

truly sick person a drug seeker and fail to treat them. Get this: I

have had my pancreas removed so you would expect very low level of

enzymes on test from me and this is true. I still have flare ups of

pain from time to time. Sometimes they are so bad I do have to go the

ER. I tell doctors my history which is well documentated anyhow and

still some of them order amalyse and lipase tests and refuse to treat

my pain because my levels are low. Freakin' morons. Pardon me! just

venting...

It is a sad state that pancreatitis is so seldom understood by

emergency docs. The best advice I can give is to go to a hospital

that seems to have a clue if you can find one, additionally get the

doctor who treats the pancreatitis to understand the issue and maybe

prepare a packet that can be taken to the ER that explains the

issues, and preferred treatment and the doctor's phone number so the

ER docs can call if they are confused.

Hope that helps,

Bert

> Is it true that if your levels are not elevated, you can still be

> having an accute attack of Pancreatitis. I ask this question

because

> my Fiance, went the ER on Sunday and they ran his Lipase and Amylase

> and they were well within normal range. I have never seen his

levels

> this normal. The doctor refused to give him any pain medication and

> we went home. The next day he went to a different hospital and his

> levels were the same, but they gave him pain medication.

>

> Wouldn't your pancrease not register Lipase and Amylase unless it

was

> signigicantly impaired/not functioning? Why do the doctors run this

> test if it does not mattter how high or low your levels are? If it

is

> not a determining factor in diagnosis pancreatitis, why do they even

> run the test?

>

[Guest guest]

Sam, yes, you can still have an acute attack without having your enzymes

elevated. This usually happens when the pancreas has " burned out " so

that it can no longer produce enough enzymes to be even a normal level,

let alone elevated. This doesn't necessarily mean the pain will go away,

as it believed by some regarding " burnout " . It does help some, but not

others. Unfortunately, I'm not one of them. I've reached burnout, but

my pain is still there, just as strong. Some doctors are not aware of

this as they don't spend much time on pancreatitis in medical school.

The reason they use the Lipase and Amylase tests is that it is usually

good to tell if someone is having an acute attack. It's only the ones

who are chronic who usually don't have elevated levels.

I'm sorry your fiance is having problems. Why do you say he is

" drug-seeking " ? Does he have a normal level of pain medication to take

at home to deal with every day pain from the pancreas? If chronic

pancreatitis has gone on long enough, the pain never goes away, it just

gets a little less after an acute attack and some sort of pain

management is needed. Have you talked to him about going to a pain

management clinic?

Kimber

--

Kimber

Vallejo, CA

hominid2@...

Note: All advice given is personal opinion, not equal to that of a licensed

physician or health care professional.

[Guest guest]

Hi Sam, I've had the exact same problem at the ER. I was in so much

pain and the doctor came back with the blood test results and my

lipase was under 100. As Chronic panc advances it kills off pancreas

cells and therefore there are less cells producing enzymes. I am in

the advanced stages and have only 5-10% of my pancreas left

functioning. So my lipase numbers mean nothing. I actually had an ER

resident doctor accuse me of going to the ER for the drugs. I took out

my MS Contin pill bottle and showed hime about 90 pills and said I

came here for relief, I have enough morphine to get this whole ER

high. My problem is I was nauseous and could't keep them down. I hope

this helps...good health to all...Jim in Vermont