severe AP.1 • Jaundice in patients with AP points to an obstructive origin, most likely secondary to the presence of gallstones in the extrahepatic biliary tree.

Figure 2-1 Intracellular transport of digestive enzymes and lysosomal hydrolases. Digestive enzymes and lysosomal hydrolases are synthesized in the rough endoplasmic reticulum (RER). Newly synthesized enzymes are transported to the Golgi complex (GC) adjacent to the nucleus (N). A, The normal separation of lysosomal hydrolases, which are transported to lysosomes (L) and digestive enzymes. The digestive enzymes are then concentrated in condensing vacuoles (CV) and zymogen granules (ZG) that fuse with the luminal plasma membrane and release their contents into the luminal space by exocytosis. B, The changes induced in mice fed the CDE diet, which blocks exocytosis and causes digestive enzymes and zymogen granules to accumulate. The zymogen granules fuse with lysosomes (crinophagy), causing the formation of large vacuoles (V) that contain both lysosomal hydrolases and digestive zymogens. C, In rats given infusions of supramaximal doses of cerulein, transport to the Golgi complex is unaffected. Impaired separation of lysosomal hydrolases and digestive zymogens results in the formation of large vacuoles that contain both types of enzymes. Mature zymogen granules also fuse with these vacuoles by a process analogous to crinophagy. Exocytosis at the luminal plasma membrane is blocked. (From Steer, M. L„ and Meldolesi, J.: The cell biology of experimental pancreatitis. N Engl. J. Med., 316:144, 1987. Reprinted by permission of The New England Journal of Medicine.)

TABLE 2-3 -- Diagnosis of Acute Pancreatitis

Laboratory Tests

Radiographic Procedures

Serum amylase

Plain chest roentgenography

Serum amylase isoenzymes

Plain abdominal roentgenography

Urinary amylase


Amylase-creatinine clearance ratio

Computed tomography

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