From the Guidelines
Amylase and lipase are not typically included in the evaluation of elevated liver enzymes, as they are pancreatic enzymes that specifically indicate pancreatic inflammation or damage rather than liver dysfunction. The standard liver enzyme panel includes alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and bilirubin 1. While there can be some overlap in symptoms between liver and pancreatic conditions, amylase and lipase are primarily used to diagnose pancreatic disorders, particularly acute pancreatitis 1.
In certain cases where there's suspicion of both pancreatic and liver involvement, or when the clinical picture is unclear, a clinician might order both liver enzymes and pancreatic enzymes. However, in a standard workup specifically targeting elevated liver enzymes, amylase and lipase would not be included as they don't directly reflect liver function or damage. The most recent guidelines from 2019 support this approach, emphasizing the use of CT-scan with intravenous contrast for diagnosing duodeno-pancreatic injuries in hemodynamically stable or stabilized trauma patients, and repeated measurement of serum amylase and lipase levels for suspicion of pancreatic injury 1.
Some key points to consider in the evaluation of elevated liver enzymes include:
- The interpretation of abnormal liver chemistries must be taken in the clinical context of a given patient 1
- The initial evaluation of abnormal liver tests includes a detailed history, inventory of medications, and a physical examination 1
- The choice of diagnostic technique at admission must be based on the hemodynamic status 1
- CT-scan with intravenous contrast is essential in diagnosing duodeno-pancreatic injuries in hemodynamically stable or stabilized trauma patients 1
Overall, the evaluation of elevated liver enzymes should focus on liver-specific enzymes and tests, rather than pancreatic enzymes like amylase and lipase.
From the Research
Evaluation of Elevated Liver Enzymes
- The evaluation of elevated liver enzymes typically involves a range of tests, including serum amylase and lipase measurements, to determine the underlying cause of the elevation 2.
- Serum amylase and lipase concentrations can be elevated in patients with chronic liver diseases, such as liver cirrhosis, due to decreased liver metabolism of these enzymes 2.
- However, the presence of elevated amylase and lipase does not necessarily indicate pancreatitis, as these enzymes can be elevated in other conditions, such as renal insufficiency, malignant tumors, and hypertriglyceridemia 3.
Role of Amylase and Lipase in Evaluation
- Amylase and lipase are not typically included in the initial evaluation of elevated liver enzymes, but may be measured in certain clinical scenarios, such as abdominal pain or suspected pancreatitis 4, 5.
- The measurement of pancreatic isoamylase and lipase can provide more sensitive and specific markers of pancreatic enzyme levels in the blood, particularly in patients with non-pancreatic diseases 5, 6.
- However, routine analysis of amylase or lipase activities in patients with non-pancreatic diseases is not indicated, as pancreatic abnormalities are unlikely to be found in these patients 6.
Clinical Implications
- Elevated serum amylase and lipase levels can have various underlying causes, including pancreatic and non-pancreatic diseases, and require careful evaluation to determine the underlying cause 3, 2.
- A systematic approach to patients with elevated amylase and/or lipase is critical to making an accurate diagnosis and initiating appropriate treatment 4.