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CLINICAL CHEMISTRY

CLINICAL ENZYMOLOGY | PANCREATIC ENZYMES


Enzyme Molecular Description & Function Clinical Significance Notes

 Pancreatic and Intra-Abdominal Diseases


 Catalyzes hydrolysis of 1,4-α- – Elev P-AMY
 Acute Pancreatitis rise within 5-8 hrs of
glycosidic linkages in polysaccharides  Genitourinary Diseases – Elev S-AMY
symptom onset, returns normal by 3rd or  Full activity is displayed only in
 Calcium Metalloenzymes  Ectopic Pregnancy
4th day. Max conc in 12 to 72 hrs presence of Chloride, Bromide,
 Optimum pH is at 6.9 to 7.0  Salpingitis
 Greater increaase in Urine AMY and Nitrate, Cholate, or Monohydrogen
 Isoenzymes  Ovarian Malignancy
will persist longer than in serum Phosphate
 S-Amylase  Miscellaneous (S-AMY)
 Increases in abdominal disorders and  Bromide and Chloride as the most
α-Amylase - Ptyalin  Salivary Gland Lesions
extrapancreatical conditions effective activators
- Action terminated by acid in  Acute alcohol Abuse
 4x P-AMY: Biliary Tract Diseases  The only Plasma enzyme found in
stomach  Diabetic Ketoacidosis
 4x or more: Intra-abdominal events the urine because it is able to pass
- Inititate hydrolysis of starch  Septic Shock
 Renal Insufficiency: Increase is prop to thorugh the glomeruli (MW 54 000
 P-Amylase  Cardiac Surgery
extent of renal impairment uusally no more to 62 000 Da)
- Released by acinar cells  Tumors
than 5x (both S and P)
- Nonglycosylated  Drugs
 Macroamylasia – maybe S or P

 Single chain glycoprotein with MW of  Acute Pancreatitis : Inc within 4-8 hrs after attack, peak at about 24 hrs return to normal  More pancreas specific
Lipase 48 000 Da and IpH of 5.8 within 7 to 14 days (2-50 x elevation)  Cocnentration in pancreas >5000x
 Chromosome 10  > 3 x , absence of renal failure = Pancreatitis than in other tissues

 Hydrolyzes peptide bonds formed by  TRY-1 : 25,800 Da pI = 4.6 to


carboxyl groups of lysine or arginine 6.5
with other amino acids although  TRY-2: 22,900 Da pI > 6.5
 Normal: TRY 1 = 2x-4x TRY-2
esters and amides involving these
 Pancreatic Disease: Ratio is reversed  TRY-1 Major Form found in
amino acids split more rapidly than
Trypsin  TRY-1 elevated in Chronic Renal Failure serum
peptide bonds
 TRY-2 10xmore Elev in Acute Pancreatitis and larger amounts excreted in urine.  TRY-2 Rapidly goes autolysis at
 Zymogens: Trypsinogen 1 (cationic)
 Urine TRY-2 high specificity and Negative Predictive Value but Low PPV neutral pH and not stabilized by
and 2 (anionic)
 Converted to Trypsin by Enterokinase calcium ions
in the Intestinal Tract

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