From the Guidelines
To evaluate elevated lipase levels, a comprehensive approach is necessary, starting with a thorough clinical assessment and confirmation of the elevation with repeat testing, as lipase is considered a more reliable diagnostic marker of acute pancreatitis than serum amylase 1. When assessing elevated lipase levels, it is crucial to consider the clinical context, as lipase can be elevated in conditions beyond pancreatitis, including renal failure, intestinal inflammation, and certain tumors.
- The diagnosis of acute pancreatitis should be established within 48 hours of admission, based on compatible clinical features and elevations in amylase or lipase levels, with lipase being preferred due to its higher sensitivity and larger diagnostic window 1.
- Additional laboratory tests, including amylase, liver function tests, triglycerides, calcium levels, and complete blood count, should be ordered to identify potential causes and assess the severity of the condition.
- Imaging studies, such as abdominal ultrasound and contrast-enhanced CT scan, are essential for evaluating the pancreas and biliary system, and for confirming the diagnosis of pancreatitis 1.
- For persistent unexplained elevations, consider magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasound (EUS) to further investigate the cause of the elevated lipase levels.
- Management should target the underlying cause, while providing supportive care, including pain control, hydration, and nutritional support as needed, and addressing potential causes such as gallstones, alcohol use, medications, hypertriglyceridemia, and hypercalcemia 1.
From the Research
Elevate Lipase Workup
- Elevated serum lipase levels can be found in various conditions, including pancreatic and nonpancreatic diseases 2
- Serum lipase levels are not specific for pancreatitis and can be elevated in many intra-abdominal inflammatory conditions 2
- Abdominal imaging is essential in diagnosing acute pancreatitis, especially in patients with painless lipase elevation 3
Diagnostic Approach
- A systematic approach to patients with elevated lipase levels is critical to making an accurate diagnosis and initiating appropriate treatment 4
- The diagnosis of acute pancreatitis requires two of the following: upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 5
- Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated in the diagnosis of acute pancreatitis 5
Nonpancreatic Hyperlipasemia
- Nonpancreatic hyperlipasemia (NPHL) is defined as a serum lipase level greater than 3 times the upper limit of normal without characteristic pain or imaging 6
- The leading etiologies for NPHL are decompensated cirrhosis and renal failure 6
- Patients with NPHL are significantly older and have more comorbidities and lower serum lipase levels compared to those with acute pancreatitis 6
Clinical Implications
- Elevated serum lipase levels can have many nonpancreatic origins, with liver and renal failure being the most frequent 6
- Distinct clinical features can help to differentiate between acute pancreatitis and NPHL 6
- Abdominal imaging increases the diagnosis of acute pancreatitis in patients with painless lipase elevation 3