## Pancreatic Enzyme Markers in Acute Pancreatitis **Key Point:** Serum lipase is superior to amylase for diagnosis of acute pancreatitis — it remains elevated longer (7–14 days vs 3–5 days) and is more specific (95% vs 85%). ### Comparison of Diagnostic Markers | Marker | Sensitivity | Specificity | Time to Peak | Duration | Notes | |--------|-------------|-------------|--------------|----------|-------| | **Serum Lipase** | 95% | 95% | 24–48 hrs | 7–14 days | **Gold standard** — more organ-specific | | **Serum Amylase** | 85% | 85% | 12–24 hrs | 3–5 days | Earlier rise but shorter window; less specific (also from salivary glands, bowel) | | **Procalcitonin** | Variable | Variable | 12–24 hrs | Days | Marker of systemic inflammation/infection; not diagnostic for pancreatitis | | **CRP** | 70–80% | 60% | 48–72 hrs | Prolonged | Reflects severity and necrosis; poor early diagnostic value | **High-Yield:** Lipase ≥3× upper limit of normal + compatible clinical features = diagnostic for acute pancreatitis. A normal lipase at 24–48 hours does NOT exclude the diagnosis if measured early. **Clinical Pearl:** In severe pancreatitis, lipase may be disproportionately elevated compared to amylase. Amylase can be normal in chronic pancreatitis (depleted acinar reserve), but lipase is often still elevated. **Mnemonic:** **LIPASE** = **L**onger duration, **I**ncrease specificity, **P**ancreas-specific, **A**mylase is less reliable, **S**ensitive & specific, **E**arly marker of choice.
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