Gastrointestinal System Disorders Q 88

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Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient?

  

    A. Serum creatinine and BUN

    B. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

    C. Serum amylase and lipase

    D. Cardiac enzymes

    

    

Correct Answer: C. Serum amylase and lipase

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Pancreatitis involves the activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis. The diagnosis of acute pancreatitis has been defined by the Revised Atlanta Classification and requires at least 2 of 3 criteria to be met: 1) a lipase or amylase level that is three times the upper limit of normal 2) abdominal pain that is consistent with pancreatitis 3) abdominal imaging consistent with acute pancreatitis.

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Option A: Early changes in BUN level may reflect several important physiologic processes in acute pancreatitis. In addition to intravascular volume depletion, a rise in BUN level may be secondary to impairment in renal function or potentially concurrent upper gastrointestinal hemorrhage. Renal failure is a relatively common form of organ dysfunction among patients with acute pancreatitis

Option B: Jaundice with increased ALT suggests gallstone etiology requiring ERCP. ALT or AST levels more than three times the upper limit of normal indicates gallstones as the cause of acute pancreatitis. However, the absence of elevated transaminases does not rule out gallstones. ALT has high specificity, but low sensitivity for gallstone pancreatitis.

Option D: Acute pancreatitis can be associated with electrical changes mimicking acute coronary syndrome with normal coronary arteries. The association of acute pancreatitis with ST-segment elevation and elevated cardiac enzymes has been reported in few observations. The pathophysiological mechanisms of this association remain poorly understood.

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