Question: 45 YO white male. Have a history of high triglycerides and sustained periods of heavy drinking, especially over the past 9 months. Chronically overweight 200 lbs 5'10.
I am one week out of shoulder surgery and was feeling persistently lousy - upper right abdominal pain and mild nausea - went to walk in clinic - they took blood and Lipase is 160 or "three times over normal". Doctor suspects pancreatitis and wants me to have a CAT Scan. I am hesitant to go for the test as my history includes already 5 CAT scans and i am worried about cumulative radiation burden.

After an episote of heavy drinking 4 years ago and similar symptoms, that same Lipase enzyme cam back at 95 and further tests showed nothing [CAT SCAN and Ultrasound].

Thoughts?

Thanks a lot for this high quality reply.

1-Amylase levels are normal, as they were during the first episode 4 years ago. Does that change anything to the course of action [see article abstract below]
2-Would the EUS identify possible cancer of the pancreas?

Looking forward to hear back

Abstract of a research paper i found online on the topic:

"Amylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature. XXXXXXX B1, Gottlieb K.
Author information
1Abteilung für Gastroenterologie, Medizinische Klinik, Krankenhaus Landshut-Achdorf, Landshut, Germany.
Abstract
OBJECTIVE:
This study was undertaken to identify clinical scenarios in which the lipase is significantly elevated (three times above the upper limit of normal) but the amylase is normal, and to examine whether or not pancreatitis is the likely cause for this seemingly unusual constellation of laboratory results.
METHODS:
Twenty-five patients were retrospectively identified over a 2-yr period, which fulfilled the above criteria. A thorough review of their charts was conducted. In addition, a critical review of the literature was performed.
RESULTS:
It appears that isolated elevation of lipase in this case series was either related to renal insufficiency (two patients), to nonpancreatic sources of lipolytic enzymes due to malignant tumors (two), to acute cholecystitis (two) or esophagitis (one), to delayed blood withdrawal (at least five patients), to hypertriglyceridemia (two), or to subclinical pancreatitis in patients without abdominal pain (three).
CONCLUSIONS:
1. An elevated lipase should not be equated with evidence for pancreatitis if the amylase is normal. 2. A simultaneous determination of both amylase and lipase is recommended for the evaluation of patients with abdominal pain."