Amylase and Lipase

As we already know amylase and lipase are pancreatic enzymes. Lipase is synthesized and stored as granules in the pancreas. Its main function is to break down triglycerides into glycerol and fatty acids. Aside from pancreatic lipase, there is also lingual, intestinal, gastric, lipoprotein and hepatic lipase. Lipase is small and therefore can be filtered by kidney, but as compared to amylase it can be reabsorbed by the kidney. Amylasehas the primary function of breaking down starch into smaller polysaccharides in the process of digestion. The major sources of amylase are located in the pancreas and salivary glands. Lipase is more sensitive and specific than amylase.

Elevation of amylase and lipase indicates an increase in pancreatic or extrapancreatic production of these enzymes or decrease excretion. In patients with elevated amylase/lipase 3x the normal suspect acute pancreatitis. However, in patients with chronic pancreatitis and alcoholic pancreatitis elevation might not be as significant. These enzymes can also be elevated during trauma to the pancreas, pancreatic ductal obstruction, surgery, post-ERCP.

Serum amylase can be elevated in conditions like obstruction, mesenteric ischemia, perforated viscus, renal failure and ectopic pregnancy. Acidosis, neoplasms, salivary infection, obstruction, or trauma. Drugs like nitrofurantoin, aspirin, chlorthalidone, codeine, thiazide diuretics, metronidazole.

Serum lipase can be elevatedalso in renal failure, acute cholecystitis, bowel obstruction, pancreatic tumors, DKA, DM2, HIV, celiac disease, sarcoidosis, IBD. Drugs like cholinergics, furosemide, methylprednisolone, metronidazole, oral contraceptives, thiazides, DPP-4 inhibitors.

Sources:

• Lyu, Heather G., and Thomas E. Clancy.. “Pancreas.” Current Diagnosis & Treatment: Surgery, 15e Gerard M. Doherty.New York, NY: McGraw-Hill, , http://accessmedicine.mhmedical.com.york.ezproxy.cuny.edu/content.aspx?bookid=2859&sectionid=242159168.
• https://www-uptodate-com.york.ezproxy.cuny.edu/contents/approach-to-the-patient-with-elevated-serum-amylase-or-lipase?search=amylase%20and%20lipase&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Five Antibiotics

1. Augmentin→It is important to have on board antibiotics covering gram positive organisms like staphylococcus, streptococcus and enterococcus. This antibiotic can treat cellulitis, abscess, pneumonia, complicated UTIs, impetigo, bacterial rhinosinusitis and other infections.
2. Ceftriaxone→It is also essential to have antibiotics covering gram negative organisms. Ceftriaxone is a good antibiotic to cover for difficult-to-treat organisms like pseudomonas and gram negative bacteria. It can treat skin and soft tissue infections, intra-abdominal, osteomyelitis, prosthetic joint infections and UTIs, bacteremia, COPD exacerbation, pneumonia which are other common hospital ailments. It can be used as surgical prophylaxis.
3. Vancomycin→It is important to have on board a strong antibiotic that can fight resistance organisms like MRSA or life-threatening infections caused by gram + organisms resistant to penicillin. In hospitalized patients receiving antibiotics development of C. difficile could become a problem. Enterocolitis due to C. difficile can be treated with vancomycin. This antibiotic can also treat community/hospital/ ventilator acquired pneumonia and meningitis. I think vancomycin is an important antibiotic to have in a hospital.
4. levofloxacin→fluoroquinolones are broad spectrum antibiotics with good gram positive and negative coverage. They can treat lower respiratory tract infection, bone and joints infections, UTIs, skin infections, STDs and infectious diarrhea.
5. Erythromycin→Penicillin allergy is overreported in clinical practice. I think it is ideal to have an antibiotic that can be prescribed in cases of penicillin allergy. This antibiotic can cover for other ailments such as STDs, URI, OM, pneumonia, Lyme disease, pertussis, and can be used for surgical prophylaxis.