Question

A female presenting with abdominal pain, distension, organ failure in last 24 hours. CT scan shows pancreas which is bulky & there is fluid density lesion in the pancreas. Which of the following will be increased.

• A. AST
• B. Lipase
• C. Creatine Kinase
• D. Blood Urea Nitrogen

Hint:

A bulky pancreas with fluid density on CT in an acutely ill patient points to pancreatitis -- think which pancreatic enzyme is most specific.

Answer 1

The Correct Option is B

Diagnosis: Acute Pancreatitis

CT findings of a bulky pancreas with peripancreatic fluid density lesion + acute presentation with organ failure = acute pancreatitis.

Key enzyme to remember:

• $\text{Lipase}$ -- produced exclusively by pancreatic acinar cells; rises in 4-8 hours, peaks at 24 hours, persists for 8-14 days
• More specific than amylase (amylase is also produced by salivary glands, ovaries, fallopian tubes)
• Diagnostic threshold: $>3$ times the upper limit of normal

Other options explained:

• AST: elevated in hepatocellular damage (not pancreatitis primarily)
• CK: marker of skeletal/cardiac muscle injury
• BUN: may rise secondary to prerenal failure in severe pancreatitis, but not the primary diagnostic marker

\[\boxed{\text{Answer: Lipase}}\]