Amylase

and lipase
serum
 Alfa-Amilase Serum
1 ml
Reagen Amilase
0,02 ml Serum

λ 405 nm pada 37⁰C

N : < 100 U/L

 LIPASE Serum
1 ml
Reagen LIPASE Inkubasi 2 menit 0,25 ml
0,02 ml Serum pada 37⁰C Reagens 2

N : < 60 U/L
λ 578 nm pada 37⁰C
1. Makroamilasemia dan Pankreatitis akut, akan didaptkan suatu
keadaan yang sama yaitu kadar Alfa-amilase yang tinggi didalam
darah. Jelaskan bagaimana tindakan saudara untuk menjelaskan
perbedaan-nya!.
2. Hampir 80 % dari penyebab pankreatitis (pankratitis akut) adalah
batu empedu yang disebakan oleh Konsumsi minuman beralkohol
dalam jangka waktu yang lama (pankratitis kronik). Jelakan
bagaimana mekanisme terjadinya pankreatitis akuta yang
disebabkan oleh batu empedu!.
 1. Batu empedu
2. Alkoholisme
3. Obat-obat, seperti furosemide, ACE inhibitor
4. Infeksi virus
5. Kadar lemak darah yang tinggi, terutama trigliserida
6. Kerusakan pankreas karena pembedahan atau endoskopi
Pankreatitis 7. Kerusakan pankreas karena luka tusuk atau luka tembus
8. Kanker pankreas , batu saluran pankreas, porfiria
9. Berkurangnya aliran darah ke pankreas, misalnya karena tekanan
darah yang sangat rendah
10.Kadar kalsium yang tinggi dalam darah
11.Estrogen : timbul peningkatan TG
12.Genetik
 Suddenly becomes inflamed
Acute Pancreatitis (AP)
Autodigestion Caused by premature zymogen or enzyme reflux

Progressive irreversible destruction of

Chronic Pancreatitis (CP)
inflammatory disease the pancreas

Periductular Protein Plug

Obstructive Scarring Formation

extensive fibrosis
(i.e., necrosis–fibrosis sequence).
 Gallstones
Gallstones Are a common cause of pancreatitis
stopping pancreatic enzymes from traveling
Produced in the gallbladder Block the bile duct to the small intestine and forcing them back
into the pancreas.

Begin to irritate the cells

of the pancreas

the inflammation
pancreatitis.
 Effect of alcohol on fragility of zymogen and Lysosome
Long term alchohol consumption Premature activatioan of zymogen enzym

Alcohol ↑ the synthesis of digestive sysytem

Alcohol consumption lead to ↑ in fragility of lysosome dan

zymogen granule allowing zymogen leakage to cell

Alcoholic metabolits make fragile zymogen granule and lysosomal

membrane .

So due fragile membrane lysosomal enzyme (cathepsin B) will activate

How fragility start auto trypsinogen to trypsin which further lead to active other enzyme and
digestion of pancreas start the cascade of event or autodigestion of pancreas .

Trypsin can not be degraded by protective enzyme of acinar cell .

 Alcohol Chronic Pancreatitis
Alcohol

Oxidative pathway Non-Oxidative pathway

Necrosis

Acetaldehyde Cytokines Fatty acid ethyl ester (FAEEs)

+ Cholesteryl esters
Pancreatic Stellate Cell Activation

Pancreatic fibrosis
 secretory block
Hypercalcemia Pancreatic Injury
(related to deposition of calcium in the pancreatic duct)

calcium ions

Activate trypsinogen within the

pancreatic parenchym

Inducing the damage (acinar cell injury) causing

the inflammation associated with pancreatitis
 Hypertriglyceridemia or chylomicronemia

Chylomicrons contain triglycerides Obstruct capillaries Local ischemia and aciduria

Excess Release very high

toxicity of acinar cells
Triglycerides concentration of FFAs

• Premature activation of trypsinogen to trypsin within the pancreas,

leading to activation of other digestive enzymes and autodigestion of
the gland

• Activated enzymes released into the pancreas and surrounding tissues

produce damage and necrosis of the pancreatic tissue, surrounding fat,
vascular endothelium, and adjacent structures

• Release of cytokines by acinar cells injures those cells and enhances the
inflammatory response
Hypertriglyceridemia Causes Pancreatitis

Estrogen treatment Aggravate hypertriglyceridemia

increasing

VLDL
(Very low density lipoprotein)

synthesis in liver slices maintained in organ culture

was stimulated by the administration of estradiol-17β
(E2) in vitro.
 LIPASE PANKREAS
100% 100%
Lipase 1,2 diasilgliserol Lipase 2 monoasilgliserol
TG pankreas + FA pankreas + FA Epitel usus

Epimerase
22% 28% 72%

Gliserol Lipase pankreas 1-monoasilgliserol Triasilgliserol

6%
Masuk ke dalam
epitel usus
Lipase pankreas

Triasilgserol masuk pembuluh limfatik dan gliserol masuk ke vena porta

Fatty acid ( FA ) digunakan untuk pembentukan triasilgliserol
 tidak dapat memotong ikatan α-(14)
glukosidik yang terletak diujung.
Enzim -Amylase Endopolisakaridase
Tak dapat memotong ikatan α-(14)
glukosidik pada glukosa yang terletak
sebelum titik cabang.

Amilum

Rangkaian glukosa rantai lurus Maltosa dan sedikit

Amilosa Produk
dengan ikatan -1,4-glukosidik glukosa

-1 +2 +2 -1
AMILOPEKTIN Ikatan alfa (1-6) dan ikatan alfa (1-4)
2
1
Keterangan gambar :
titik cabang, dimana
amilase tidak dapat bekerja 1

3
Ikatan glukosidik 4
-(1,6)

2
1 1 5 1 1 1 1

1. Amilase bekerja memotong ikatan 𝛂 1 →4 menjadi :

2 = maltose (dua glukosa)
3 = maltriosa (tiga glukosa)
4 = Glukosa
5 = limit dekstrin (oligo sakarida, 4 hingga 10 glukosa
 Pankreas Pankreatitis
Mukosa Usus
ENZIM LIPASE Jaringan Lemak
Lekosit
Lambung

Kelenjar Liur Parotitis

Tidak Didapatkan
diserap kembali oleh ginjal sehingga
urine
tidak dipengaruhi oleh penyakit ginjal

• Lipase pankreas lebih spesifik dan sensitif daripada amylase pankreas untuk dignosis
pankreatitis
• Kadar lipase darah tidak cepat menurun, maka masih berguna untuk diagnostik setelah
beberapa hari serangan.
Kelainan Pankreas Lipase Serum Lebih Meningkat Dibanding Amilase Serum

Pankreatitis Akut Test Lipase Lebih Sensitif Dibanding Test Amilase

Kombinasi Keduanya Sensitifitasnya 95-97 %.

10% 30 %
Penderita Pankreatitis Akut Penderita Pankreatitis Kronis

Test Amilase

Normal
 When

Amylase serum Lipase serum

Elevated Increases Normal Non-pancreatic

Elevations > 5 x 3-5 times hyperamylasemia

upperre ference limit
(URL)

Considered

Pathognomonic for pancreatitis

Lipase serum Elevated Specific Pancreatic Disease Normal

7 - 14 days
Amylase serum Elevated Non-Specific Normal

2 - 3 days
 Salivary glands

Amylase
Fallopian tubes Ectopic Pregnancy serum amylase Elevated

lesser extent Brain Lung Liver Spleen Kidney Intestine

Muscle Adipose tissue

Some lung tumors Serous ovarian tumors Most body fluids and excretions

However activity under normal conditions 40- 45% of the circulating blood

Derived from the pancreas

 Amylase

IF

Salivary Glands Pancreas

Blood Damaged or Blocked Urine

Increase May Remain High

Only A Short Time Several Days

Serum Levels Since this excretion is relatively rapid

Borderline Or Norma
 Amilase dalam serum dan urine

Protein Yang Dapat Sebagian Diserap

Amilase Melalui Glomeruli Kembali Oleh Tubuli
Urine

Pada penderita dengan kelainan ginjal,

amilase dalam serum akan tetap tinggi,
meskipun amilase dalam urine rendah.

Nilai normalnya mempunyai variasi yang leb

Pemeriksaan amilase dalam Kelemahan
urine sering juga dilakukan pemeriksaan Pemeriksaan harus dikerjakan pada
urine yang dikumpulkan dalam waktu
tertentu

Protein akan meningkatkan aktifitas

amilase didalam urine
 Is The Presence Of An Macroamylase
MACROAMYLASEMIA
Abnormal Substance In The Blood

has been recently described as a cause of persistently elevated serum amylase levels

Pancreatitis due to a macromolecular complex too

This elevation without
Renal disease large to be filtered at the glomerulus.

substance that consists

Macroamylase Amylase Attached to a protein.
of an enzyme
Because It Is Filtered Very Slowly From Most people with Do Not Have A
Large The Blood By The Kidneys macroamylasemia Serious Disease

Celiac disease
HIV infection
Lymphoma
Ulcerative colitis
Rheumatoid arthritis
Monoclonal gammopathy
 will show high levels of amylase,
However, macroamylasemia can look similar to acute
A blood test
pancreatitis, which also causes high levels of amylase in
the blood.
MACROAMYLASEMIA

Measuring amylase levels in the urine MACROAMYLASEMIA

low / normal in people high in patients with

Apart from acute
with macroamylasemia acute pancreatitis.
pancreatitis.
 A high molecular weight form of amylase.
IgA (70%)
Macroamylasemia circulates as a complex with immunoglobulins
IgG (30%).

renal excretion is impaired causing a

Due to its size
persistently raised serum amylase.
In this condition, amylase/creatinine clearance ratio described below is
usually < 1% ( normal 1- 3- 5% ), and the urine amylase is usually low.

Amylase/Creatinine Clearance ratio described below is usually < 1%

In This Condition
( normal 1- 3- 5% ), and the urine amylase is usually low.

In pancreatitis values range from 5% to greater than 20%

Amylase Serum Amylase SerumCreatinine

Creatine Clearance Ratio
= Urine Amylase
× Urine Creatinine
× 100 %
 Diagnosis Of Macroamylasemia
Patient presents with In elevated serum amylase 150 U/L
Serum lipase Yes Normal No suspect acute pancreatitis

Urine amylase Yes Usually Low No suspect acute pancreatitis

Elevated Amylase Secundary

Renal function Yes Normal No
to Renal Deasease

Serum Amylase SerumCreatinine PEG precipitation test

Urine Amylase
× Urine Creatinine
× 100 % Yes No
positive?

Diagnosis of Chromatography by gel

macroamyalasemia filtration positive?
 Differential Diagnosis of Hyperamylasemia and Macroamylasemia

Urinary Serum
Condition Serum amylase Serum lipase Cam : Ccr
amylase macroamylase

Pancreatic
High High High High Absent
hyperamylasemia

Salivary Low or Low or

High Normal Absent
hyperamylasemia normal normal

Macroamylasemia High Normal Low Low High