Serum Enzymes in GI Tract Serum Enzymes in GI Tract DiseasesDiseases

• The enzymes of GI tract regularly assayed are:-

• Serum Amylase 80 to 180 Somogyi Units

per 100 ml

• Serum lipase 9 to 20 m IU Saligman & Nachlas

Serum LipaseSerum Amylase is the investigation of choice in Acute PancreatitisSerum activity as >than 1000 units in 24 hrsNormalizes in 3 daysSince the enzyme is secreted by the parotid glandRaised values not exceeding 1000 units are found in mumps

Amylase assay is also used in the differential diagnosis of

MeningioencephlitisFacial swellingRaised Amylase not exceeding 500 units

are indicative ofi) perforated peptic ulcer

ii) Intestinal obstruction

Serum Lipase•Serum Lipase is more specific in pancreatic disorders’

•Remains raised for longer periods,but not as preferred due to lack of quick assay methods

•During acute pancreatitis raised levels are found promptly as symptoms occur.

•Elevated levels persists for10 to 14 days

•Values as high as 2800 U/L have been reported

•Elevated in perforated duodenal and peptic ulcers

Serum Enzymes in Muscle diseasesSerum Enzymes in Muscle diseases

Enzyme assays done in muscle Enzyme assays done in muscle diseases arediseases are

SGOT / SGPT ( not used now )SGOT / SGPT ( not used now )

AldolaseAldolase

CPKCPK

Serum Aldolase (2 to 6 mIU) Moderate increase in Muscular

dystrophy and dermatomyositis

Highest values in Duechenne type of muscular dystrophy

Also increases in viral hepatitis and myocardial infarction

What is Duchene muscular dystrophy? Duchenne muscular dystrophy (DMD) is a rapidly

progressive form of muscular dystrophy that occurs primarily in boys.

It is caused by an alteration (mutation) in a gene, called the DMD gene that can be inherited in families in an X-linked recessive fashion, but it often occurs in people from families without a known family history of the condition.

Individuals who have DMD have progressive loss of muscle function and weakness, which begins in the lower limbs. The DMD gene is the second largest gene to date, which encodes the muscle protein, dystrophin.

Boys with Duchenne muscular dystrophy do not make the dystrophin protein in their muscles.

Duchenne muscular dystrophy affects approximately 1 in 3500 male births worldwide. Because this is an inherited disorder, risks include a family history of Duchenne muscular dystrophy

Serum CPK in Muscle diseases4 to 60 IU / L

CPK assay is more sensitive and specific in muscle disorders.

Slightly raised in nurogenic muscular dystrophyand muscular dermatomyositis , about 1000IU/L

Duechene type 10,000 IU /L Also raised in Hypothyroidism due to

secondary muscle disease

Serum Enzymes in Bone DiseasesSerum Alkaline Phosphatase

This is the only useful enzyme assay utilized

Most valuable index of Osteoblastic activityOsteomalacia,hyperparathyroidism, particularly Paget’s disease

Elevated levels also observed in • Bone Malignancies• Hypophosphatasia

Chief Enzyme AssaysChief Enzyme Assays

In MalignanciesIn Malignancies

ENZYME S .Acid Pase

S. Alk Pase

DISEASECancer of Prostrate

with or without metastasis

Metastasis in Liver

Osteoblastic Metastasis in bone

Jaundice due to carcinoma of pancrease

Serum LDH

AldolasePhosphohexose isomerase

ß-Glucuronidasein urine and serum

Leucine AP

• Widespread Malignancies

• Advanced Leukemias

• Cancer urinary bladderCancer head pancreas

• Liver carcinomaPrimary , secondary hepatoma