The document discusses serum enzyme levels in gastrointestinal tract diseases, muscle diseases, bone diseases, and malignancies. For GI tract diseases, serum amylase and lipase are used to diagnose acute pancreatitis. Serum lipase is more specific but lacks quick assay methods. For muscle diseases, aldolase and CPK are used, with Duchenne muscular dystrophy showing the highest CPK levels. For bone diseases, alkaline phosphatase is the primary enzyme assay and is elevated in conditions like osteomalacia and Paget's disease. Common enzyme assays for malignancies include acid phosphatase, alkaline phosphatase, LDH, aldolase, and leucine aminopeptidase.

1. Serum Enzymes in GI TractSerum Enzymes in GI Tract
DiseasesDiseases
• The enzymes of GI tract regularly
assayed are:-
• Serum Amylase  80 to 180 Somogyi
Units
per 100 ml
• Serum lipase  9 to 20 m IU Saligman &
Nachlas

2. Serum Lipase
Serum Amylase is the investigation of choice
in Acute Pancreatitis
Serum activity as >than 1000 units in 24 hrs
Normalizes in 3 days
Since the enzyme is secreted by the parotid
gland
Raised values not exceeding 1000 units are
found in mumps

3. Amylase assay is also used in the
differential diagnosis of
Meningioencephlitis
Facial swelling
Raised Amylase not exceeding 500 units
are indicative of
i) perforated peptic ulcer
ii) Intestinal obstruction

4. Serum Lipase
•Serum Lipase is more specific in pancreatic
disorders’
•Remains raised for longer periods,but not as
preferred due to lack of quick assay methods
•During acute pancreatitis  raised levels are
found promptly as symptoms occur.
•Elevated levels persists for10 to 14 days
•Values as high as 2800 U/L have been
reported
•Elevated in perforated duodenal and peptic
ulcers

5. Serum Enzymes in Muscle diseasesSerum Enzymes in Muscle diseases
Enzyme assays done in muscleEnzyme assays done in muscle
diseases arediseases are
 SGOT / SGPT ( not used now )SGOT / SGPT ( not used now )
 AldolaseAldolase
 CPKCPK

6. Serum Aldolase (2 to 6 mIU)
 Moderate increase in Muscular
dystrophy and dermatomyositis
 Highest values in Duechenne type
of muscular dystrophy
 Also increases in viral hepatitis and
myocardial infarction

7. What is Duchene muscular dystrophy?
 Duchenne muscular dystrophy (DMD) is a rapidly
progressive form of muscular dystrophy that occurs
primarily in boys.
 It is caused by an alteration (mutation) in a gene, called
the DMD gene that can be inherited in families in an X-
linked recessive fashion, but it often occurs in people
from families without a known family history of the
condition.
 Individuals who have DMD have progressive loss of
muscle function and weakness, which begins in the lower
limbs. The DMD gene is the second largest gene to date,
which encodes the muscle protein, dystrophin.
 Boys with Duchenne muscular dystrophy do not make
the dystrophin protein in their muscles.
 Duchenne muscular dystrophy affects approximately 1 in
3500 male births worldwide. Because this is an inherited
disorder, risks include a family history of Duchenne
muscular dystrophy

8. Serum CPK in Muscle diseases
4 to 60 IU / L
 CPK assay is more sensitive and
specific in muscle disorders.
 Slightly raised in nurogenic muscular
dystrophy
and muscular dermatomyositis ,
about 1000IU/L
 Duechene type 10,000 IU /L
 Also raised in Hypothyroidism due to
secondary muscle disease

9. Serum Enzymes in Bone Diseases
Serum Alkaline Phosphatase
This is the only useful enzyme assay
utilized
Most valuable index of Osteoblastic
activity
Osteomalacia,hyperparathyroidism,
particularly Paget’s disease
Elevated levels also observed in
• Bone Malignancies
• Hypophosphatasia

10. Chief Enzyme AssaysChief Enzyme Assays
In MalignanciesIn Malignancies

11. ENZYME
 S .Acid Pase
 S. Alk Pase
DISEASE
Cancer of Prostrate
with or without
metastasis
Metastasis in Liver
Osteoblastic
Metastasis in bone
Jaundice due to
carcinoma of
pancrease

12. Serum LDH
Aldolase
Phosphohexose
isomerase
ß-Glucuronidase
in urine and serum
 Leucine AP
• Widespread
Malignancies
• Advanced
Leukemias
• Cancer urinary
bladder
Cancer head
pancreas
• Liver carcinoma
Primary ,
secondary
hepatoma