Home Laboratory values Pancreatic enzymes (Pancrelipase): What your laboratory values ​​mean

Pancreatic enzymes (Pancrelipase): What your laboratory values ​​mean

by Josephine Andrews
Published: Last Updated on 386 views

Pancreatic enzymes are important laboratory parameters to detect suspected damage to the pancreas. Elevated amylase and lipase levels are often an indication of acute inflammation of the pancreas (pancreatitis). Learn more about the importance of pancreatic enzymes here!

What are pancreatic enzymes?

Pancreatic enzymes are digestive enzymes produced by the pancreas ( pancreas ). The organ produces one to two liters of digestive juice per day, which flows through the main duct (pancreatic duct) into the duodenum – the first section of the small intestine. Pancreatic juice contains the following pancreatic enzymes:

  • Enzymes that break down carbohydrates (alpha-amylase, glucosidases)
  • Enzymes that break down fat ( lipase , phospholipase A and B, cholesterol esterase)
  • Enzymes that split nucleic acids (deoxyribo- and ribonucleases)
  • Enzymes that break down proteins (trypsin, chymotrypsin, elastase , collagenase, kallikrein, carboxypeptidase)

Most of the pancreatic enzymes are released by the pancreas as precursors, as so-called zymogens: trypsinogen, chrymotrypsinogen, procarboxypeptidases and prophospholipase A. They are only converted into their active form in the small intestine , which then participates in the digestion of the food eaten.

If the pancreatic enzymes are already activated within the pancreas due to illness, the organ digests itself. This is called acute pancreatic necrosis.

How many pancreatic enzymes are released is regulated on the one hand by the vagus nerve and on the other by hormones . These are hormones that are produced in the intestinal cells or in the so-called islet cells of the pancreas. For example, the hormone cholecystokinin (= pancreozymin) stimulates the release of pancreatic enzymes.

When is the pancreatic enzyme determined?

The pancreatic enzymes are determined primarily when damage to the pancreas is suspected. Such organ damage can result from inflammation, poisoning , tumors or excessive alcohol consumption. Pancreatic enzymes can also be measured to check enzyme production in the pancreas.

Of the various pancreatic enzymes, amylase and lipase are the leading enzymes. They can be determined by taking a blood sample . For reasons of cost, both pancreatic enzymes are often not determined at the same time. Lipase is usually measured because it remains elevated longer than amylase and many patients do not go to the doctor right at the beginning of an illness.

amylase

Within a few hours of the onset of symptoms, blood amylase increases . The highest value is reached after 20 to 30 hours. This falls off quickly after three to five days. The amylase measured in the blood from the pancreas accounts for 40 percent of the total amylase activity. The remaining amylase comes mainly from the salivary glands.

The amylase in the urine increases over time. Due to the lower hit rate, however, the urine test is hardly used anymore.

lipase

The enzyme lipase in the body comes mainly from the so-called acinus cells of the pancreas. In the blood, the lipase rises within four to eight hours after the onset of the disease and falls again within 8 to 14 days. It therefore remains elevated longer than amylase.

Pancreatic enzymes: reference values

In a healthy person, only a small proportion of the pancreatic enzymes enter the blood directly or indirectly via the lymphatic system.

The amylase concentration is not measured in its absolute amount, but in enzyme activity units (units, U) per liter of substrate (blood serum, spontaneous urine, collected urine). In the following table you will find the reference values ​​​​for adults:

normal values pancreatic amylase

(measurement at 37°C)

serum < 100U/L
spontaneous urine < 460 U/l
collection urine < 270 U/l

Depending on the measurement method used, the reference values ​​can differ, so only approximate values ​​can be given here.

The lipase blood value will be determined in the serum. The unit of measurement U/l stands for the enzyme unit (U) per liter.

pancreatic lipase
Adult 13 – 60 u/l
children up to 40 U/l

When are pancreatic enzymes low?

With chronic inflammation of the pancreas (chronic pancreatitis) and pancreatic cancer , it can happen that the gland no longer produces enough digestive enzymes. The measured values ​​for the pancreatic enzymes are then reduced. Doctors speak of exocrine pancreatic insufficiency .

When are pancreatic enzymes elevated?

Elevated pancreatic levels in the blood together with symptoms such as severe upper abdominal pain, nausea, vomiting and fever indicate an acute inflammation of the pancreas (acute pancreatitis). It can be triggered by diseases of the bile ducts, excessive alcohol consumption, and less commonly, infections, surgery, or medications.

Other important causes of elevated pancreatic enzymes include:

  • benign and malignant pancreatic tumors
  • Pseudocysts or duct narrowing (strictures) after acute pancreatitis
  • other diseases involving the pancreas such as gastrointestinal perforation, intestinal obstruction (ileus), mesenteric infarction
  • Drugs such as azathioprine , 6-mercaptopurine, mesalazine , the ” pill “, opiates, or antibiotics; increased pancreatic lipase from anticoagulants (such as heparin)

What to do with altered pancreatic enzymes?

If a patient has low pancreatic enzymes (and thus exocrine pancreatic insufficiency), the cause must be clarified. The doctor then usually determines the amount of elastase in the stool and carries out a special test (secretin-pancreozymin test).

Slightly elevated pancreatic levels are usually no cause for concern. Even healthy people have slightly elevated pancreatic enzymes in their blood in up to five percent of cases. It is mostly people with functional disorders of the gastrointestinal tract in which the pancreatic enzymes are elevated.

If the pancreatic enzyme values ​​are elevated, the doctor will carefully take a medical history, especially with regard to digestive problems, previous illnesses and medication intake. This is followed by a physical examination and further examinations and laboratory tests to clarify possible causes.

For example, if acute pancreatitis is suspected, further laboratory parameters are measured and imaging studies are carried out (such as ultrasound , computer tomography with contrast media, magnetic resonance imaging).

If the cause of the changed blood levels of pancreatic enzymes is determined, the doctor will initiate appropriate treatment.

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