Clinical Laboratory Essay

Question:

Case study on Clinical Laboratory.

Answer:

The abnormal values identified after the chemistry test and hematology test were Amylase which after rechecking reported to be 265 IU/L, lipase 320 IU/L, ??GT IN THE FIRST TEST SHOWED 335 IU/L, HDL was found 35 mg/dL, WBC count was slightly more 10.8 x 10 9/ L and ESR was found 40 mm/h (Banks et al., 2013).
  • According to Banks et al. (2013), elevation in the level of amylase and lipase indicates inflammation of the pancreas which is commonly known as pancreatitis. The increase in the two enzymes is the cause of nausea, vomiting, and severe abdominal pain. The increase in the level of gamma glutamyltransferase indicates pancreatic disorders. According to the clinical report, the level of HDL is lower than the normal concentration present in an unaffected individual. HDL cholesterol is notably lower in patients with severe acute pancreatitis.
  • The origin of pancreatitis in seventy percent of the cases is alcohol; twenty percent is considered idiopathic and ten percent for other reasons such as "Hyperparathyroidism,” “Cystic Fibrosis,” etc.

In the first stage of the pathogenesis, the enzyme trypsin gets activated which n turn activates several other pancreatic digestive enzymes such as lipase, amylase, etc. This digestive enzyme leads to self digestion of the pancreatic cells. In the last phase, this inflammation spreads to the other organs of the patient (Tenner et al., 2013).

  • As stated by Tenner et al. (2013), “the most common cause of acute pancreatitis is gallstone impacting the distal common bile-pancreatic duct.” Another major cause of pancreatitis is excessive consumption of alcohol.
  • Three other causes of pancreatitis are:
  • Hereditary reasons
  • Increase consumption of glycemic foods is linked with the elevated risk of non-gallstone acute pancreatitis.
  • Consumption of anti-diabetic drugs such as "glucagon-like peptide one agonist" used by diabetes patient increases the chance of pancreatitis (Singh et al., 2013).

The two enzymes that are critical in the diagnosis of pancreatitis are amylase and lipase.

The optimum temperature at which amylase is active ranges between 32 to 37 degree centigrade and at 50 degree centigrade salivary amylase gets denatured. The optimum pH for amylase is 6.7.

In terms of lipase, the optimum is 8.8.m temperature is 37 degree centigrade and optimum pH (Singh et al., 2013).

The five other cause of amylase elevation are:

  • Ectopic pregnancy. This occurs only in pregnant patients, thus different from pancreatitis.
  • Salivary gland blockage. In this case, inflammation occurs in the parotid gland and pancreatitis occurs in the pancreatic gland.
  • Pancreatic Pseudocysts. On performing CT scan presence of cyst is observed in patients with pancreatic pseudocysts but absence in pancreatitis patients.
  • Pancreatitis involves abdominal pain whereas; mumps involve throat pain and swelling.
  • Sputum evaluation in case of pneumonia indicates the presence of bacterial strain whereas in pancreatitis the result would be negative (Singh et al., 2013).

WBC count according to the hematology is more which indicates that inflammation or infection (Yadav et al., 2013).

“An elevated amylase-creatinine clearance ratio has been established as being highly specific for the diagnosis of acute pancreatitis. This ratio is used to assess kidney function because the improper function can result in a slower rate of amylase clearance” (Yadav et al., 2013).

Severity and prognosis: Age > 55 yrs

WBC count > 16,000 µL

BUN ?‚ 5 mg

According to Yadav et al. (2013), in this case, the patient is less than 55 years and WBC count is not too much and the BUN is within the normal range. Thus, the patient condition is not so serious (Hart et al., 2013).

The four important complications are:

  • Pancreatic necrosis which might occur due to interruption in blood supply
  • Pseudocyst which might develop due to a collection of debris in cyst-like sacs.
  • Systematic inflammatory response syndrome occurs due to the spread of the infection.
  • Chronic pancreatitis occurs on repeated episodes of acute pancreatitis (Hart et al., 2013).
The usual treatment involves medications for the pin, receiving of intravenous fluids to reduce dehydration, procedures used to remove the bile duct obstruction and surgery (Hart et al., 2013).

References:

Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G., ... & Vege, S. S. (2013). Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut, 62(1), 102-111.

De Leonibus, C., Lembo, C., Giliberti, P., Rojo, S., Foglia, M. C., Giordano, L., & Fratta, A. (2012). [A case of neonatal lupus syndrome and congenital atrioventricular block associated with maternal antibodies antiRo/SS-A].Minerva pediatrica, 64(2), 251-256.

Hart, P. A., Kamisawa, T., Brugge, W. R., Chung, J. B., Culver, E. L., Czak?, L., ... & Kawa, S. (2013). Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut, 62(12), 1771-1776.

Heelan, K., Watson, R., & Collins, S. M. (2013). Neonatal lupus syndrome associated with ribonucleoprotein antibodies. Pediatric dermatology, 30(4), 416-423.

Katsanos, K. H., Voulgari, P. V., & Tsianos, E. V. (2012). Inflammatory bowel disease and lupus: a systematic review of the literature. Journal of Crohn's and Colitis, 6(7), 735-742.

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