Asymptomatic Hyperamylasemia, Hyperlipasemia

1 B-II. , Room B. Amylase, Lipase .. Asymptomatic Hyperamylasemia, Hyperlipasemia Seok Ho Dong, Hoe-Hoon Chung Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea .. , 1.. , 40~45% . 2.. , , , .. 1.. , , , , , , . 3.. 25% .. , 75% .. 4,5.. , .. , . Table1. Pathogenic Mechanisms and Possible Causes for Increased Serum Levels of Pancreatic Enzymes Release of Pancreatic Enzymes into the Blood Renal Clearance Mild duct obstruction Acinar cells damage Renal diseases Macroamylasemia Biliary causes Biliary lithiasis Sphincter of Oddi Drugs Inflammatory Celiac disease dysfunction (SOD) Alcohol Neoplastic Crohn's disease Periampullar tumours Virus (hepatitis) Ulcerative colitis Anatomic anomalies Vascular Autoimmune disease Choledochocele Surgery (rheumatoid artritis, systemic Pancreatic causes Autoimmunity Impaired renal function lupus erythematosus).

2 Pancreatic Tumours HIV. Anatomic Anomalies Lymphoma Gene mutations (?) Thyroid cancer Santorinicele Renal cells carcinoma Duodenal causes Paravaterian diverticulum Periampullar tumours J Pancreas 2005;6(6):536-551. 47 103. Amylase, Lipase . 6,7. (Table 1, 2). , . 9.. 10.. HIV , , , .. 8.. 2.. Table 2. Causes of Hyperamylasemia .. Pancreatic Disease I. Pancreatitis . A. Acute B. Chronic: ductal obstruction , . C. Complications of pancreatitis .. 1. Pancreatic pseudocyst 42 5 . 2. Pancreatogenous ascites 3. Pancreatic abscess 19% . 11. Pancreatic necrosis , .. II. Pancreatic trauma . III. Pancreatic carcinoma . Gullo . Nonpancreatic Disorders I. Renal insufficiency . II. Salivary gland lesions 18 , , , . A. Mumps . B. Calculus C. Irradiation sialadenitis CAPH (chronic Asymptomatic pancreatic hyperenzynemia). 12. D. Maxillofacial surgery.

3 III. "Tumor" hyperamylasemia . A. Carcinoma of the lung . Antonio CAPH. B. Carcinoma of the esophagus C. Breast carcinoma, ovarian carcinoma 160 2005 2010 6 MRI, MCRCP . IV. Macroamylasemia . 18. V. Burns VI. Diabetic ketoacidosis Table 3. Pathological MR Findings Before (MR-MRCP) and After VII. Pregnancy Secretin Stimulation (s-MRCP) in 160 Subjects with CAPH. VIII. Renal transplantation MR-MRCP s-MRCP. IX. Cerebral trauma MR parameters P-value (%) (%). X. Drugs: morphine Normal 117 ( ) 80 (50) < Other Abdominal Disorders Cysts 4 ( ) 4 ( ) NS. I. Biliary tract disease: cholecystitis, Diffuse MPD dilation 7 ( ) 31 ( ) < choledocholithiasis Segmental MPD dilation 7 ( ) 11 ( ) NS. II. Intraabdominal disease Diffuse side branch dilation 5 ( ) 41 ( ) < A. Perforated or penetrating peptic Focal side branch dilation 15 ( ) 17 ( ) NS.

4 Ulcer Santorinicele 2 ( ) 5 ( ) NS. B. Intestinal obstruction or infarction Delayed MPD empting 0 23 ( ) < C. Ruptured ectopic pregnancy Mass 5 ( ) 5 ( ) NS. D. Peritonitis No. of subjects with 1+findings 43 ( ) 80 (50) < E. Aortic aneurysm F. Chronic liver disease Am J Gastroenterol 2012;107:1089-1095. G. Postoperative hyperamylasemia CAPH, chronic Asymptomatic pancreatic hyperenzymemia; MPD, main pancreatic duct; MR, magnetic resonance; MRCP, magnetic resonance Harrison's 18th edition p2632 Table 312-2. cholangiopancereatography; NS, not significant. 104 Korean Society of Gastrointestinal Endoscopy Amylase, Lipase . Fig. 1. Possible diagnostic algorithm in patients with pancreatic hyperenzynemia. J Pancreas 2005;6(6):536-551. 3 1996;62:1028. 10% , 2. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 1990;19:783.

5 , , , , 3. Terada T, Kida T, Nakanuma Y. Extrahepatic peribiliary glands , 40 g express alpha-amylase isozymes, trypsin and pancreatic lipase: . CAPH an immunohistochemical analysis. Hepatology 1993;18:803-8. 4. Tietz NW, Shuey DF. Lipase in serum the elusive enzyme: an MR-MRCP overview. Clin Chem 1993;39:746-756. 27% , MRCP 50% 5. The role of the kidney in the elimination of pancreatic lipase (Table 3). 13 and amylase from blood. J Clin Chem Clin Biochem 1985;23: 387-92. LUCA 2005 CT 6. Luca F, Franca P, Laura B, Giorgio C. Pancreatic hyperenzymemia: Clinical significance and diagnostic approach. J Pancreas 2005;. MRCP MRCP 6:536-551. 6 7. Harrison's 18th edition p2632 Table 312-2. (Fig. 1). 8. Sachdeva CK, Bank S, Greenberg R, et al. Fluctuation in serum amylase in patients with macroamylasemia. Am J Gastroenterol 1995;90:800.

6 9. Ben-Horin S, Farfel Z, Mouallem M. Gastroenteritis associated hyperamylasemia: prevalence and clinical significance. Arch Intern Med 2002;162:689. , , , , 10. Gregory A, Jeanne H, Gottstein B, et al. The Role of Etiology in the Hyperamylasemia of Acute Liver Failure. Am J Gastroenterol . , . 2009;104:592. CT , 11. Gullo L. Day-to-day variations of serum pancreatic enzymes in MRI MRCP benign pancreatic hyperenzymemia. Clin Gastroenterol Hepatol . 2007;5:70-74. 12. Gullo L . Chronic nonpathological hyperamylasemia of pancre- atic origin. Gastroenterology 1996;110:1905-1908. 13. Antonio A, Riccardo M, Anna Maria K, et al, Prospective Evaluation of Subjects With Chronic Asymptomatic Pancreatic 1. Chase CW, Barker DE, Russell WL, et al. Serum amylase and Hyperenzymemia. Am J Gastroenterol 2012;107: 1089-1095. lipase in the evaluation of acute abdominal pain.

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