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Lipase


Definition


  • Glycoprotein enzyme filtered by glomeruli and completely reabsorbed by proximal tubules; method should always include colipase in reagent
  • Normal range: 0 " “50 U/L

Use


  • Investigating pancreatic disorders, usually pancreatitis
  • More specific for pancreatitis than is for serum amylase; diagnosis of peritonitis, strangulated or infarcted bowel, pancreatic cyst

Interpretation


Increased In


  • Acute pancreatitis
  • Perforated or penetrating peptic ulcer, especially with involvement of the pancreas
  • Obstruction of pancreatic duct by
    • Stone
    • Drug-induced spasm of sphincter of Oddi (e.g., codeine, morphine, meperidine, methacholine, cholinergics) to levels 2 " “15 times normal
    • Partial obstruction plus drug stimulation
  • Chronic pancreatitis
  • Acute cholecystitis
  • Small bowel obstruction
  • Intestinal infarction
  • Acute and chronic renal failure (increased two to three times in 80% of patients and five times in 5% of patients)
  • Organ transplant (kidney, liver, heart), especially with complications (e.g., organ rejection, CMV infection, cyclosporin toxicity)
  • Alcoholism
  • DKA
  • After ERCP
  • Some cases of intracranial bleeding (unknown mechanism)
  • Macro forms in lymphoma, cirrhosis
  • Drugs
    • Induced acute pancreatitis (see preceding section on serum amylase)
    • Cholestatic effect (e.g., indomethacin)
    • Methodologic interference (e.g., pancreozymin [contains lipase], deoxycholate, glycocholate, taurocholate [prevent inactivation of enzyme], bilirubin [turbidimetric methods])
  • Chronic liver disease (e.g., cirrhosis) (usually ≤2 times normal)

Decreased In


  • Methodologic interference (e.g., presence of Hb, quinine, heavy metals, calcium ions)

Normal In


  • Mumps
  • Macroamylasemia
  • Lower value in neonates

Limitations


  • Certain drugs such as cholinergics and opiates may elevate serum lipase.
  • Renal disease may elevate the serum lipase.
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