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The causes of increase and decrease of lipase
Last reviewed: 19.10.2021
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In acute pancreatitis, the activity of lipase in the blood increases within a few hours after the onset of the disease, reaching a maximum (up to 200 times) after 12-24 hours, and remains elevated for 10-12 days. The prognosis of the disease is considered unfavorable if the lipase activity in the blood rises by 10 times or more and does not decrease to a 3-fold excess of the norm within the next few days. The diagnostic sensitivity of lipase in the serum in acute pancreatitis is 86%, specificity - 99%. Simultaneous determination of the activity of α-amylase (in blood and urine) and lipase is the basis for the diagnosis of acute pancreatitis. An increase in both or one of the enzymes reveals in 98% of patients with acute pancreatitis.
Unlike amylase, lipase activity does not increase with parotitis, ectopic pregnancy, lung cancer, appendicitis. The edematous form of acute pancreatitis, as a rule, is not accompanied by an increase in lipase activity; fatty pancreonecrosis is characterized by a marked increase in its activity, persisting up to 2 weeks; and with hemorrhagic pancreatic necrosis it increases (on average 3.5 times) for a short time on the 3-5th day of the disease. With purulent pancreatitis, increased lipase activity in the blood is usually not detected. Sometimes an increase in lipase activity is found in patients with pancreatic cancer, chronic pancreatitis, with a cyst in the pancreas.
Serum lipase activity is highly sensitive, especially with regard to the diagnosis of acute alcoholic pancreatitis, while for patients with obstructed bile ducts, large duodenal papilla and pancreatic ducts, high amylase activity is characteristic. In this regard, to establish the etiology of acute pancreatitis, the lipase-amylase coefficient is sometimes calculated: the ratio of lipase activity to serum amylase activity. The value of the lipase-amylase coefficient above 2 allows to diagnose acute alcoholic pancreatitis (sensitivity - 91%, specificity - 76%). Only in patients with acute alcoholic pancreatitis the coefficient may be higher than 5.
An increase in lipase activity in the blood may occur with intestinal infarction, peritonitis, biliary colic. An increase in the activity of lipase in the blood during the destruction of adipose tissue - fractures of bones, wounds of soft tissues, after operations, in breast cancer.
Hyperlipazemia with uremia and acute renal failure is a consequence of stagnation in the pancreas.