CHAPTER 1

CLINICAL BIOCHEMISTRY II
LBC10303

DMLT: CLINICAL BIOCHEMISTRY II

(LBC10303)
DMS: CLINICAL BIOCHEMISTRY
(QCH10203)

1 Madam Azura binti Abd Wahid

azura@msu.edu.my
Session: FEB 2019

CHAPTER 1:
PANCREAS DYSFUNCTION

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LBC10303

Subtopics
3
 Topic Outcomes
 Introduction to Pancreas
 Disorders relating to pancreas
 Laboratory Diagnosis

4 TOPIC OUTCOMES

Discuss the anatomy and physiology of pancreas in terms of

the endocrine and exocrine components of this organ

Explain the pancreatic-related diseases in relation to
disruption of the normal function

Describe the laboratory diagnosis used in diagnosing
pancreatic problems

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LBC10303

6 INTRODUCTION TO PANCREAS

Anatomy of Pancreas:

Elongated, flat, tapered organ (~6 inches long)

Located deep within the abdominal cavity, below the liver
and between the stomach and the spine.

Divided into 4 main parts:

Head – widest, lies in the curve of duodenum

Neck

Body

Tail - near spleen

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LBC10303

8 INTRODUCTION TO PANCREAS

10 INTRODUCTION TO PANCREAS

Cross section of pancreas

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LBC10303

12 INTRODUCTION TO PANCREAS
• Composed of acinar cells
• These cells produce enzyme – assist in food digestion
• Enzyme and pancreatic fluid are released into smaller ducts
that eventually join together forming the main pancreatic
Exocrine duct
• Enzyme runs into the duodenum (1st part of small intestine)

• Composed of cells named as islet of Langerhans

• Release hormones (insulin and glucagon) into the
bloodstream
Endocrine • These hormones work together to maintain proper glucose
level in the blood

13 INTRODUCTION TO PANCREAS

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LBC10303

14 INTRODUCTION TO PANCREAS

Cells of Islet of Langerhans & hormones

Alpha cells – glucagon

Beta cells – insulin and amylin

Delta cells – somatostatin

Gamma (PP) cells – pancreatic polypeptide

Epsilon cells - ghrelin

16 INTRODUCTION TO PANCREAS

What is pancreatic juice?

Fluid secreted by the pancreas which contains a variety of
enzymes

Elastase

Amylase

Trypsinogen

Pancreatic lipase

Carboxypeptidase

Chymotrypsinogen

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CLINICAL BIOCHEMISTRY II
LBC10303

17 INTRODUCTION TO PANCREAS

Secretion of pancreatic juice is regulated by 2 hormones:

Secretin

Cholecystokinin
*These 2 hormones are produced by the cells in the intestine

Pancreatic fluid is alkaline (high concentration of bicarbonate

ions)

To neutralize the acidic gastric acid for effective enzymatic
reactions and avoid burning the intestine

18 DISORDERS RELATING TO
PANCREAS
Pancreatic diseases include the followings:

Diabetes Mellitus

Pancreatitis – acute & chronic

Cystic fibrosis

Pancreatic cancer

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CLINICAL BIOCHEMISTRY II
LBC10303

19 DISORDERS RELATING TO
PANCREAS: DIABETES MELLITUS

Diabetes Mellitus - A group of metabolic disease
characterized by hyperglycemia (high glucose level in blood)

3 major types:

Type 1 Diabetes (T1D)

Type 2 Diabetes (T2D)

Gestational Diabetes Mellitus (GDM)

This topic will be discussed later in Chapter 2.

20

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LBC10303

21 DISORDERS RELATING TO
PANCREAS: PANCREATITIS

Pancreatitis: inflammation of the pancreas

Mechanism:

Enzymes secreted by the pancreas are supposed to be active
once they reach small intestine

In pancreatitis, these enzymes become active inside the
pancreas  digesting pancreatic tissues

Types of pancreatitis:

Acute - painful attacks lasting a matter of days

Chronic - condition that progresses over a period of years.

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LBC10303

23 DISORDERS RELATING TO
PANCREAS: PANCREATITIS (Acute)
Acute pancreatitis

Sudden swelling and inflammation of the pancreas

Causes:

Heavy alcohol

Gallstones –blockage at the opening that drains the common
bile duct and pancreatic duct

Symptoms:

Fever, nausea, vomiting & sweating

Swollen, tender abdomen

24 DISORDERS RELATING TO
PANCREAS: PANCREATITIS (Acute)

Lab findings:

Blood amylase level

Blood lipase level

Urine amylase level
(serum amylase and lipase level arises 3x than normal value
in acute pancreatitis)

Patient may recover after receiving the right treatment.

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LBC10303

25 DISORDERS RELATING TO
PANCREAS: PANCREATITIS (chronic)
Chronic pancreatitis

Inflammation that does not heal or improve

Leads to permanent damage

Patients’ ability to digest food is impaired

Causes are similar to acute pancreatitis but may include

Autoimmune conditions

Familial pancreatitis (history)

26 DISORDERS RELATING TO
PANCREAS: PANCREATITIS (chronic)

Symptoms are similar but may include

Weight loss

Fatty stools

Pain that spreads to the back and become worse with eating/
drinking

Q: What is fatty stools? Discuss the mechanism / process that leads to fatty
stools.

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LBC10303

27 DISORDERS RELATING TO
PANCREAS: CYSTIC FIBROSIS

Cystic fibrosis: An inherited disease of the secretory glands
where thick mucus buildup affects the lungs, pancreas and
other organs.

Mechanism:

In lungs mucus clogs the airways and traps bacteria 
extensive lung damage  respiratory failure

In pancreas  mucus prevents the release of digestive enzymes
by blocking ducts of the pancreas

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LBC10303

29 DISORDERS RELATING TO
PANCREAS: CYSTIC FIBROSIS

Cause: Genetic

Symptoms:

Persistent coughing

Frequent lung infection

Greasy, bulky stool

Salty-tasting skin

30 DISORDERS RELATING TO
PANCREAS: PANCREATIC CANCER
Pancreatic cancer

Also known as pancreatic carcinoma

A malignant tumor of the pancreas

4th leading cause of cancer deaths

Cancer spreads rapidly

Signs and symptoms may not appear until cancer is quite
advanced

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32 DISORDERS RELATING TO
PANCREAS: PANCREATIC CANCER

Causes:

Genetic

Smoking

Obesity and dietary factors

Symptoms:

Back pain

Weight loss

jaundice

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34 DISORDERS RELATING TO
PANCREAS: PANCREATIC CANCER
Lab findings (generally not specific):

Serum amylase & lipase

Tumor marker

Prognosis:

Often poor – the cancer is at advanced stage at time of diagnosis

Survival rates - low

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LABORATORY DIAGNOSIS

Pancreas can be evaluated through several laboratory tests:

Secretin pancreatic function test

Fecal elastase test

Amylase test

Lipase test

Trypsinogen test

Others: Computed Topography (CT), ultrasound etc  these
test is not discussed in this subject.

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LABORATORY DIAGNOSIS

Secretin-stimulation test

Fecal elastase test

Amylase test

Lipase test

Trypsinogen test

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LBC10303

37 LABORATORY DIAGNOSIS:
1. Secretin Pancreatic Function Test
What is Secretin?

A hormone released by small intestine in the presence of
partially digested food.

Secretin stimulates the pancreas to secrete a fluid with a high
concentration of bicarbonate to neutralize acid from stomach.

Secretin pancreatic function test

Also known as secretin stimulation test

This test measure the sensitivity of pancreas towards secretin

38 LABORATORY DIAGNOSIS:
Secretin Pancreatic Function Test
How the test is performed?

This test is invasive.

A tube is placed down the throat, into the stomach, then into
the duodenum (upper section of small intestine).

Secretin is inserted (intravenously) and the contents of the
duodenal secretions are aspirated (removed with suction) for
about an hour and analyzed.

Patient is required to not drink or eat anything, including

water, for 12 hours before the test.

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CLINICAL BIOCHEMISTRY II
LBC10303

39 LABORATORY DIAGNOSIS:
Secretin Pancreatic Function Test

Interpretation: Abnormal values may mean that the pancreas
is not working properly.

The following diseases may prevent the pancreas from
working properly:

Chronic pancreatitis

Cystic fibrosis

Pancreatic cancer

41 LABORATORY DIAGNOSIS:
Fecal Elastase Test
What is Elastase?

an enzyme produced by special (exocrine-acinar cells) tissue
in the pancreas

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LBC10303

42 LABORATORY DIAGNOSIS:
Fecal Elastase Test
Elastase test:

Also known as: Elastase, Pancreatic Elastase, Fecal Pancreatic
Elastase

Sample collected: feces that is not contaminated with urine

Purpose: To help detect and evaluate pancreatic insufficiency

This test measures the amount of elastase in stool to help

evaluate whether pancreas is functioning properly.

43 LABORATORY DIAGNOSIS:
Fecal Elastase Test

Elastase is not degradable by other enzymes. Thus, its
excretion can be measured in the stool

Amount of elastase is reduced in pancreatic insufficiency

Age: All ages Range (ug elastase/g stool)

Normal >200

Moderate to slight pancreatic 100-200

insufficiency

Severe pancreatic insufficiency <100

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LBC10303

44 LABORATORY DIAGNOSIS:
Amylase Test
What is amylase?

enzyme secreted by pancreas & the gland that made saliva

purpose – to break down ____________

Amylase test:

Sample collected: blood, urine

It measures the amount of amylase in the blood or urine

Primarily to diagnose and monitor acute pancreatitis; also
sometimes to diagnose and monitor chronic pancreatitis or
other pancreatic diseases

45 LABORATORY DIAGNOSIS:
Amylase Test
Serum amylase test

Measures the amount of amylase in blood

Sample: blood collected from venipuncture (anticoagulant?)

The normal range is 40 to 140 units per liter (U/L)

Interpretation:

Increased levels – may occur due to several conditions (such as
acute pancreatitis, pancreatic duct blocked by gallstone or
pancreatic cancer in a rare case

Decreased level – may occur due to cancer of the pancreas

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CLINICAL BIOCHEMISTRY II
LBC10303

46 LABORATORY DIAGNOSIS:
Amylase Test
Amylase urine test

Measures the amount of amylase in urine.

Also known as urine diastase

Sample: clean catch urine or 24 hours urine

The normal range is 24 to 400 units per liter (U/L)

Diastase – an enzyme that breakdown starch into maltose

47 LABORATORY DIAGNOSIS:
Lipase test
What is lipase?

enzyme secreted by pancreas into small intestine

purpose – to break down ____________

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LBC10303

48 LABORATORY DIAGNOSIS:
Lipase test
Lipase test:

Sample collected: blood

It measures the amount of lipase in the blood

Patient is required to fast for 8 hours prior to the test.

Interpretation: normal results are 0 to 160 units per liter
(U/L) or 0 to 2.67 microkat/L (µkat/L).

Lipase appears in the blood when the pancreas is damaged.

50 LABORATORY DIAGNOSIS:
Trypsinogen test
What is trypsinogen?

Inactive substance that is produced in the pancreas and
released into the small intestine.

Trypsinogen is converted to trypsin.

Then it starts the process needed to break down
into their building blocks (called amino acids)

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LBC10303

51 LABORATORY DIAGNOSIS:
Trypsinogen test
Trypsinogen test:

Also known as: Serum trypsin; Trypsin-like
immunoreactivity; Serum trypsinogen; Immunoreactive
trypsin

Sample collected: blood

This test is done to detect diseases of the pancreas.

The test is also used to screen newborn babies for cystic
fibrosis.

52 LABORATORY DIAGNOSIS:
Trypsinogen test
Trypsinogen test:

Interpretation:

Increased levels – acute pancreatitis, Cystic fibrosis, pancreatic
cancer

Normal or Decreased levels – chronic pancreatitis

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LBC10303

53
REVIEW QUESTIONS

Name the test which is ideal to differentiate between

pancreatitis and pancreatic cancer.

54
THE END

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