TRC: Pancreatic enzymes

Pancreatic enzymes

Treatment of pancreatitis depends on the pathogenesis. When the pancreatic enzymes are released too early by acid activation in the duodenum (already in the pancreas itself), this activation can be prevented by fasting. When there is no acid production by the stomach, there will be no activation of pancreatic juice secretion by CCK nor GIP. Keeping gastric acid from the duodenum to prevent pancreatic secretory stimulation can also be achieved by treatment with octreotide or protease inhibitors.

In case of pancreatic exocrine insufficiency, treatment with pancreatic enzymes can be started in order to supply the lacking enzymes and allow proper digestion.

Pancreatin is a mixture of:

fat-dissolving enzyme, lipase, which catalyzes the hydrolysis of fats into glycerol and fatty acids
protein enzymes such as protease, that convert protein into peptides and amino acids
enzymes like amylase that break down starch and complex sugar molecules into smaller carbohydrates like dextrins and glucose

Pancreatin tablets are prescribed for patients who are unable to digest food properly because of an insufficient amount of natural pancreatic secretions. This deficit may be caused by disorders of the pancreas such as pancreatitis or cystic fibrosis.

When the endocrine function of the pancreas is also disturbed, suppletion with insulin might be required as well. See insulin in the chapter on Endocrinology & Metabolism.

Which of the following statements pertaining to pancreatic amylase and lipase are true?

Extra info: In the context of renal failure, serum amylase and lipase may both be elevated (approximate two-thirds of the time). Lipase elevations are seen in more advanced renal failure (CrCl < 20 mL/min) and is generally less than twice the upper limit of normal. Unlike other pancreatic enzymes that are secreted in the proenzyme form and require activation, pancreatic amylase and lipase are both secreted in the active form.

Option explanation:

Amylase, but not lipase, may be elevated in the context of renal failure

Lipase, but not amylase, may be elevated in the context of renal failure

Both amylase and lipase may be elevated in the context of renal failure

Both enzymes are secreted in a proenzyme form in the pancreas (i.e. requires activation to the active form).

Pancreatic enzymes

Pancreatic enzymes

You may also like