Re: Blocked Biliary / pancreatic ducts & enzyme levels:

[Guest guest]

Hi ,

I think what you are forgetting about is that the enzymes that get

into your intestines and mix with your food and intestinal fluid

become deactivated. Hence what does gets into your blood

through your intestines are NOT the activated lipase and

amylase enzymes but their catabolic (or breakdown) products.

This is not the same phenomenom that occurs when nutrients

from food and active metabolites from your medicine is

absorbed into your blood stream. (Well, the phenomenom is the

same - biochemical changes - but the idea that the enzyme

remains unchanged while it is being absorbed is not). As you

know, your intestine breaksdown your food and meds before

they can pass through into your blood stream. The same thing

occurs with your enzymes..in a healthy person.they are broken

down before they can enter the blood stream via the intestine.

What can enter the blood stream in an organ, may not be able to

enter the blood stream in the intestine and vice versa....because

of the whole availability of chemicals available in the different

tissues that comprise the different organs.

When you see the acitivated form of your enzymes in your blood,

that is an indication that something may be blocked....whether it

is your bile duct (for your LFTs) or pancreas (for amylase and

lipase) and possibly your duodenum (but I am not sure about

this one). These facts are not " research " but basic body

chemistry 101.....as far as blockage = elevated levels. However,

this does not mean that you can't have elevated levels without

blockage or blockage with normal levels. That all depends on

when the tests were run in the course of your blockage.....and a

multitude of other variables. When elevated levles of activated

enzymes like amylase and lipase get into your blood

stream...that is in indication that a disease process is taking

place because at no time should activated amylase and lipase

be in your blood at levels significantly higher than normal. That

would be like saying that a fasting glucose of 250 can be normal.

We all know that it isn't.....However, that value alone cannot tell

you what the abnormality in the body that is causing it to be so

high.

Again, I caution you to not compare values obtained from normal

anatomical pancreas' with those that have pancreas divisum.

The way that the enzymes enter into the duodenum is different

between the two and blockage that occurs in one duct vs the

other may influence when and how much the values raise. My

gut feeling is that when blockage occurs in PD, it is either not

enough to totally inhibit the flow of enzymes, or that the tests are

not run during the right time period to show the transient

elevations. In addition, the elevations may be very localized and

very transient (like when the biliary duct gets obstructed by SOD)

that the body is able to get values back to normal before it

becomes systemic. For example, when I had the blockage with

my SOD, the LFTs were raised significantly only within the first

12 to 24 hours after a MAJOR attack. If I ran the tests later than

24 hours I rarely saw a significant increase and if the attacks

were not major I never saw a significant increase. I am thinking

that this is the same thing with pancreas blockage.....and no, you

most likely were not 100% blocked if your enzymes were not

raised. A tiny, tiny, tiny amount of fluid was most likely able to get

out from your other papilla......it is unlikley that both of your

papillae are blocked in PD although I am sure that it could

happen as you can never say never............. Don't forget, with PD,

you have drainage from both papillae....that it is only the minor

one that is blocked when things go bad......usually the major one

is fine. Of course though, inflammation of the whole pancreas

could affect the major papilla too, but then, that should

(theoretically) show up in other lab tests to indicate that the

whole pancreas is compromised. And then you have the

exception of moderate to severe CP concomitant with PD so that

in this case, the cells that produce the enzymes are dead...so

that when the blockage that occurs with PD the enyzmes are not

produced so you will not able to see any increase in your blood.

Again, that is why there is so much controversy regarding

stenosis, blockage and relevance of PD....the thinking is that the

other duct should in some way be able to compensate for the

" relative " obstruction theorized to be happening in PD. Because,

there is no set agreement on what defines blockage in a

papilla.....the smallest wire that they use is 3 mm I think....so

theoretically, even if they cannot get a 3 mm wire through the

papilla, they may be able to get a 1 or a 2mm wire through it (if

these are available) and if so, then a person can say that even

the minor papilla is not totally blocked...that a tiny flow can go

through, enough to drain the activated enzymes before they can

become concentrated in the blood.

The reason you are seeing the elevation after your procedures is

most likely not because the activated enzymes are being drained

into your intestines but rather because the insertion of the stents,

or other messing with the ducts, are releasing the enzymes from

the cells that line the ducts and because blood flow to the

pancreas has increased due to the inflammatory response of

the insult, the enzymes are getting into the circulation. The fact

that they usually return to normal relatively quickly supports the

idea that it was a transient injury to the pancreas....not an

ongoing disease process.The enzymes that are now flowing into

your intestines are being broken down into inactivated forms to

be recylcled and / or eliminated as waste. Because by definition,

once the enzymes are in your intestine, they are

metabolized....unless the person has a concomitant metabolic

problem and cannot break down the activated enzymes...but

then, that would have shown up in numerous other ways earlier

in the life of the patient, I would think. Although, you may be able

to argue that the release of activated enzymes from the blockage

overwhelms the metabolic process in the intestine so that a

higher level than normal appears in the blood stream because

of this....but you still should be seeing them in the blood first!!!

Not after the procedure.

I hope this clears up the whole biochemistry lesson.....I am not

disagreeing that a person can experience blockage without

having raised enzyme levels. I am just pointing out that it is

nearly impossible for activated enzymes that are released into

the intestines to make it back into the blood stream through the

intestinal lining.......because biochemically, they are usually

metabolized first. Unless of course, the person is crashing and

all of the metabolic systems are failing. Then you see a raise in

everything......

Laurie