Chronic Pancreatitis and LOW Amylase/Lipase blood counts

[Guest guest]

Dear Fellow Members:

Please, can anyone relate to or advise on the following:

When I first was diagnosed with acute pancreatitis, the MD's at the Hospital

admitted me immediately due to increased Amylase and Lipase counts. I have had

chronic pancreatitis for 4 years now and what has happened is that I feel I am

having an acute episode, but when I now go to the ER, the blood counts are no

lomger ever elevated with regards to the Amylase and Lipase. The ER MD's no

longer admit me because they say I am not " acute " even though I am in

excruciating pain as before. Is there a reason the bloodwork no longer gets

elevated even though I am going through acute pancreatitis? Are there other

tests to more acurately indicate acute pancreatitis so I can get the proper care

as in the past or is the Amylase/Lipase the only indicator?

PLEASE HELP! THANKS...

Steve Ashton

__________________________________________________

[Guest guest]

Hi Steve,

What you are describing is very common when dealing with

flares of chronic pancreatitis. There are many theories about

why this happens but most knowledgeable physicians that

routinely deal with CP understand that amylase and lipase may

not, and most times do not, elevate when a patient is having

flares of pain. Howeve, most ER docs are not knowledgeable

about the signs and symptoms of CP - only AP...because acute

pancreatitis is a true emergency and is routinely seen in an ER.

The thing that is usually misunderstood by patients and

physicians is that CP is a separate entity to AP and has different

etiologies; thus you cannot use the same criteria to diagnose

and treat. That is, the textbook example of elevated amylase and

lipase is basically worthless when it comes to diagnosing flares

of CP. Again, compassionate and knowledgeable physicans will

treat the SYMPTOMS not the SIGNS (which are pain, not elevated

enzymes).

The reason that enzymes do not elevate is thought to be that the

pancreas has become so damaged that it is unable to produce

or secrete amylase and lipase. So, there are no enzymes

available to get into the blood stream. This usually happens

when the pancreas is severely atrophied, I think the common

belief is that more than 90% of the pancreas has to be " dead " .

The theory though that may explain why they don't elevate when a

person has a more viable organ deals with the way the pancreas

is harmed by CP on a cellular basis, I guess is the way to put it. I

have in the past explained this by analogy to watering systems.

In acute pancreatitis the whole organ is affected and inflammed.

Thus virtually ever cell is " leaking " enzymes into the blood

stream. I think of this as a sprinkler that waters the lawn by

tossing water into the air in large volumes over a large area. It is

not hard to see that the water is flowing and if there is a

measuring device - like a rain gauge, you can quantify the

amount of water that is squirted (analogous to blood tests for

AP). CP on the other hand, has very localized damage, not the

whole organ that is inflammed or atrophied but only small

portions - and where this damage is, cells may not be able to

" leak " enzymes because they are dead, or if they do leak, they

are leaking in such small quantities that measuring the increase

of enzymes cannot be done because our lab tests are not

senitive enough to detect the slight rise. I think of this as

analogous to using a soaker hose to water your lawn...That is,

the water is flowing but it is not obvious to the brief glance that it

is. If you were able to measure the flow at the specific place that

the water is leaking, you would be able to detect it, but putting out

a rain gauge in the middle of the lawn to measure the amount of

water squirted would be of no use - it would show that no water

has flowed. So it is with using the elevated enzyme criteria for

CP - it is not able to measure the flow at the source. If you could

somehow, do the blood test on blood obtain from the capillaries

directly next to the area of the pancreas that is inflammed and

" leaking " you may, theoretically be able to detect the increase.

So basically what may be happening is that you are having what

some doctors call " acute flares of chronic pancreaitis " . This is

not the same things as acute pancreaitis. It is now thought that

these are two distinct diseases which may not behave in the

same way thus are not diagnosed using the same criteria.

What many people on this board have done to combat this lack

of knowledge in the ER is to have a letter on hand, written by your

pancreas specialist, which clearly states that you have CP and

that pain flares do not always (and in fact may never) elevate and

that you should be treated based on symptoms and to not rely on

the usual laboratory and / or imaging studies (signs).

I am not sure if I have explained this clearly enough....I am not

thinking too well at this moment but I thought I would give it a try

and if anything, you can point out where I have caused more

confusion than explanation.

I am sure other people will be able to address this issue too!

Laurie