A client presents to the ED with a stab wound to the abdomen following an assault. It is suspected that the client has an injury to the pancreas. Which laboratory study is used to detect pancreatic injury

The laboratory investigation is to check for the levels of pancreatic enzymes amylase and lipases in the blood.

Explanation:

The pancreas is an organ that is located in the abdomen and produces digestive enzymes and hormones that aid digestion, and empties into the small intestine.

When the pancreas is inflamed, these enzymes will leak into the blood cells the concentration of the enzymes in the plasma or serum will increases above the normal range, this mostly occurs in pancreatitis (which is the inflammation of the pancreas) or a mechanical injury to the pancreas as described in this question. These enzymes are found in other organs too, but they are mainly found in the pancreas in a larger concentration.

The two main enzymes that are assayed for in the laboratory are; Amylase and lipase. Amylase is an enzyme that digests carbohydrates, for the amylase test, blood or urine is used and the patient is asked to stay away from drugs that affect the amylase levels prior to the test procedure. The normal range of amylase in the blood is 23-140 U/L and an amylase concentration of > or = 200 U/L suggests injury to the pancreas.

Lipases are enzymes that breaks down lipids into fatty acids and glycerol, this test is more sensitive than the amylase test because the liopases are reabsorbed into the blood stream in the renal tubules hence maintain a constant concentration in the blood and can accurately be used to quantify the extent of damage to the pancreas. The normal range is  0 - 160 U/L and in the case of pancreatic injury, can have a 2 or 4 fold increase in concentration.

The principle of both tests is that they measure the activity of both enzymes in the blood colorimetrically or using a spectrophotometer.

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