Blocked Biliary / pancreatic ducts & enzyme levels: and Adampist?

[Guest guest]

Adam, ,

My understanding with blocked ducts (either biliary or pancreatic)

is that enzyme levels go up, not remain normal. This is because

if the ducts are blocked, they cannot drain the enzymes into the

duodenum / small intestine so instead, the enzymes " leak " into

the blood stream. This is not to say that you cannot have normal

enzyme levels and be blocked; with pancreas ducts at least. But

classically, this is how you determine when you have stasis -

whether it is liver (cholestasis) or pancreas ducts. When the

biliary system is blocked you have elevated liver function tests

(bilirubin, alk phos, ALT, AST, LDH, etc) when you have blocked

pancreatic ducts you have elevated amylase and lipase and

sometimes LFTs (theoretically, as we all know that there are

exceptions with the pancreas). It is those that have CP - when

the tissues that produce the enzymes have died, or have

become non-functioning - then you can see flares and cases of

AP without increases in amylase and lipase.

So that is why in normal people, amylase, lipase, LFTs etc...are

all " normal " ; but in diseased states which have obstruction as a

component, can be diagnosed by elevated enzyme levels.....the

enzymes are not draining into the intestine where they are

suppose to go, but instead become activated in the organ and

move into the bloodstream which then can be found upon

analysis of your blood. In normal, healthy people, these enzymes

should not be in your blood in concentrations outside of the

normal range. You must remember that the intestine is a

separate entity than your blood system and what gets into the

intestine does not necessarily goes into your blood stream.

That being said....it is not uncommon for people with blocked

ducts in the pancreas to have normal levels of amylase and

lipase - at least with pancreas divisum. I am not sure if this

holds true with obstruction found in an anatomically normal

pancreas. This is why there is so much controversy with the

whole diagnosis of symptomatic pancreas divisum. Because,

theoretically, an obstructed pancreas should show elevated

pancreatic enzyme levels but with PD this doesn't always occur,

thus many doctors do not think that PD and the " relative "

stenosis is a cause of abdominal pain, etc. So we must take

into consideration what you find in anatomically normal

pancreas pancreatitis and SOD patients vs pancreas divisum

pancreatitis and SOD patients when we compare signs and

symptoms and treatment options. I know that it is hard to

remember but it is a relevant situation which can lead to

inadvertant mis-conclusions. I do this all the time...then have to

stop myself and look at the information all over again.

Oh, another point...is that obstruction has to be nearly complete

(that is virtually nothing can get out at all) before you will see

significant elevations, at least that is what I have been lead to

believe........ In fact I have been told that the term obstruction has

been misused in the general non-medical vernacular...that in

pure medical usage, obstruction means the complete blockage

of a duct - ONLY. However, most people (doctors included) tend

to use it to designate different degrees of blockage.

Laurie