Jemds.com Original Research Article J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 7/ Issue 11/ Mar. 12, 2018 Page 1360 LEVELS OF S. LIPASE AND S. AMYLASE IN ASSESSING SEVERITY AND CAUSE OF ACUTE PANCREATITIS Jitendra Singh Kushwaha 1 , Shri Krishna Gautam 2 , Nagendra Pratap Verma 3 , Harshit Khare 4 , Brijesh Kumar 5 , Reena Singh 6 1 Professor, Department of Medicine, GSVM Medical College, Kanpur, U. P. 2 Associate Professor, Department of Medicine, GSVM Medical College, Kanpur, U. P. 3 Senior Resident, Department of Medicine, GSVM Medical College, Kanpur, U. P. 4 Junior Resident, Department of Medicine, GSVM Medical College, Kanpur, U. P. 5 Associate Professor, Department of Medicine, GSVM Medical College, Kanpur, U. P. 6 Associate Professor, Department of Medicine, GSVM Medical College, Kanpur, U. P. ABSTRACT BACKGROUND Alcoholic acute pancreatitis may present with a wide spectrum of symptoms ranging from mild chronic abdominal discomfort to a presentation that of an acute abdomen. Diagnosing it sometimes becomes a challenge to physician. Objectives- To investigate the role of Serum Lipase to Serum Amylase ratio in differentiating alcoholic cause of acute pancreatitis from non-alcoholic acute pancreatitis, and whether levels can be correlated with CT abdomen severity score. MATERIALS AND METHODS A total of 55 patients of acute pancreatitis (AP) were admitted in Medicine Department from January 2015 to August 2016, of which 47 patients were included in the study. S. amylase and S. lipase were measured in first 48 hours simultaneously after admission and thus calculating the L/A ratio. CECT abdomen was done in 3 - 5 days after admission and grading was done by Balthazar criteria. RESULTS Among these, the lipase/ amylase ratio in alcoholic AP ranged from was significantly higher than non-alcoholic AP (mean L/A ratio in alcoholic AP was 4.03 ± 1.44; and non-alcoholic AP was 2.27 ± 0.85 with p= 0.0001), but L/A ratio was unable to distinguish between various degrees of severity in the acute pancreatitis. CONCLUSION S. lipase/ S. amylase ratio could help in differentiating the alcoholic and non-alcoholic cause of acute pancreatitis, but it does not correlate with the CT score severity of acute pancreatitis. KEYWORDS Alcoholic Acute Pancreatitis, Lipase Levels, Amylase Levels, Lipase/ Amylase Ratio. HOW TO CITE THIS ARTICLE: Kushwaha JS, Gautam SK, Verma NP, et al. Levels of S. lipase and S. amylase in assessing severity and cause of acute pancreatitis. J. Evolution Med. Dent. Sci. 2018;7(11):1360-1363, DOI: 10.14260/jemds/2018/309 BACKGROUND Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract leading to tremendous emotional, physical and financial human burden. 1 It is usually a short-lived inflammatory response to pancreatic gland injury. Typical symptoms include abdominal pain, nausea and vomiting. As atypical presentations of acute pancreatitis are frequent and there is a wide differential diagnosis, confirmatory tests are required to confirm the diagnosis as well as assess the severity of acute pancreatitis. ‘Financial or Other Competing Interest’: None. Submission 07-02-2018, Peer Review 25-02-2018, Acceptance 28-02-2018, Published 12-03-2018. Corresponding Author: Shri Krishna Gautam, H. N.27, New Type IV Faculty Quarters, GSVM Medical College Campus, Kanpur-208002, U. P. E-mail: dr.gautamhal@gmail.com DOI: 10.14260/jemds/2018/309 Three enzymes derived from pancreatic acinar cells- amylase, lipase and the proenzyme trypsinogen have been tested as biochemical markers of acute pancreatitis; and although elevated serum pancreatic enzymes support clinical diagnosis of acute pancreatitis, numerous reports however describe the lack of usefulness of serum enzyme levels to determine the prognosis in acute pancreatitis as well. 2-5 Currently, serum amylase and serum lipase are the most commonly used of these in clinical practice. 6 Although, Cherry and Crandal 7 first described an association between pancreatic injury and elevated serum lipase levels in 1932, the routine study of serum lipase levels gained widespread popularity quite later. There are many causes of acute pancreatitis of which gall stone is the commonest (30% - 60%) followed by alcohol (15% - 30%). In the Western countries alcohol is the most common cause of acute pancreatitis, 8-12 but a diagnostic workup must be undertaken to identify treatable causes. 13 Identification of gallstones as the aetiology should prompt referral for cholecystectomy to prevent recurrent attacks and potential biliary sepsis. 14,15 However, alcohol-induced pancreatitis often manifests as a spectrum ranging from discrete episodes of acute pancreatitis to chronic irreversible silent changes. 15