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Oct 27, 2023

Acute pancreatitis?

36. A 40-year-old alcoholic male is admitted with severe epigastric pain radiating to
the back. Serum amylase level is reported as normal (fluoroscopic method), but
serum lipase is elevated. The serum is noted to be milky in appearance. A
diagnosis of pancreatitis is made. The serum amylase is normal because:
A. The patient has chronic renal failure
B. The patient has hyperlipidemia
C. The patient has alcoholic cirrhosis
D. The patient has alcoholic hepatitis
E. The diagnosis of pancreatitis is incorrect
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Oct 27, 2023
The correct answer is B. The patient has hyperlipidemia.

In acute pancreatitis, both serum amylase and lipase levels are typically elevated. However, in rare cases, serum amylase may be normal while serum lipase is elevated. This can occur in patients with hyperlipidemia, as high levels of triglycerides can interfere with the measurement of amylase. The milky appearance of the serum is also suggestive of hyperlipidemia, as it indicates the presence of chylomicrons.
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