Question

Which of the following is a hallmark of acute pancreatitis?

• A. Elevated amylase and lipase
• B. Decreased amylase and lipase
• C. Elevated bilirubin
• D. Decreased alkaline phosphatase

Hint:

“Acute pancreatitis: Lipase>Amylase for diagnosis.”

Answer 1

The Correct Option is A

Step 1: Understanding acute pancreatitis
Acute pancreatitis is an inflammatory condition of the pancreas that occurs when digestive enzymes become prematurely activated within the pancreas itself, leading to autodigestion and inflammation. This results in a rapid onset of abdominal pain, nausea, and vomiting.

Step 2: Key laboratory markers
The hallmark biochemical feature of acute pancreatitis is a significant rise in serum amylase and serum lipase levels. These enzymes are normally secreted into the small intestine to aid digestion, but during inflammation, they leak into the bloodstream.
Normal serum amylase range: 23–85 U/L
Normal serum lipase range: 0–160 U/L
In acute pancreatitis, both can rise to three times or more above the upper limit of normal.

Step 3: Why lipase is more specific than amylase
While both amylase and lipase rise in pancreatitis, lipase has higher specificity because amylase can also be elevated in conditions such as salivary gland disorders, perforated ulcers, or intestinal obstruction. Lipase elevation is more directly linked to pancreatic injury.

Step 4: Why other options are incorrect

• Decreased amylase and lipase: Does not occur in acute pancreatitis; both are elevated.
• Elevated bilirubin: May occur in gallstone pancreatitis due to biliary obstruction but is not the hallmark feature.
• Decreased alkaline phosphatase: Unrelated to acute pancreatitis; alkaline phosphatase is elevated in biliary obstruction.

Step 5: Clinical correlation
If a patient presents with severe epigastric pain radiating to the back, nausea, vomiting, and tenderness in the abdomen, measuring serum amylase and lipase is essential for diagnosis. Imaging (ultrasound or CT scan) can confirm pancreatic inflammation, but enzyme elevation is the primary laboratory hallmark

Elevated amylase and lipase = Key diagnostic hallmark of acute pancreatitis