Acute pancreatitis and normoamylasemia. Not an uncommon combination.
Pierre-Alain Clavien,John Robert,P. Meyer,François Borst,Herman Hauser,François Herrmann,Viviane Dunand,Adrien Rohner +7 more
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AP does not appear to behave differently when serum amylase is normal or elevated, and should therefore be submitted to similar therapeutic regimens in both conditions, although there was a tendency for normoamylasemic patients to follow milder courses.Abstract:
A consecutive series of 352 attacks of acute pancreatitis (AP) was studied prospectively in 318 patients. AP was ascertained by contrast-enhanced CT scan in all but four cases in which diagnosis was made at operation or autopsy. Sixty-seven of these cases (19%) had normal serum amylase levels on admission (i.e., less than 160 IU/L, a limit that includes 99% of control values), a figure considerably higher than generally admitted. When compared to AP with elevated serum amylase, normoamylasemic pancreatitis was characterized by the following: (1) the prevalence of alcoholic etiology (58% vs. 33%, respectively, p less than 0.01), (2) a greater number of previous attacks in alcoholic pancreatitis (0.7 vs. 0.4, p less than 0.01); and (3) a longer duration of symptoms before admission (2.4 vs. 1.5 days, p less than 0.005). In contrast AP did not appear to differ significantly in terms of CT findings, Ranson's score, and clinical course, when comparing normo- and hyperamylasemic patients, although there was a tendency for normoamylasemic patients to follow milder courses. Serum lipase was measured in 65 of these normoamylasemic cases and was found to be elevated in 44 (68%), thus increasing diagnostic sensitivity from 81% when amylase alone is used to 94% for both enzymes. A peritoneal tab was obtained in 44 cases: amylase concentration in the first liter of dialysate was greater than 160 IU/L in 24 cases (55%), and lipase was greater than 250 U/L in 31 cases (70%). Twelve of these 44 cases had low peritoneal fluid and plasma concentrations for both enzymes. Thus little gain in diagnostic sensitivity was obtained when adding peritoneal values (96%) to serum determinations. AP is not invariably associated with elevated serum amylase. Multiple factors may contribute to the absence of hyperamylasemia on admission, including a return to normal enzyme levels before hospitalization or the inability of inflamed pancreases to produce amylase. Approximately two thirds of cases with normal amylasemia were properly identified by serum lipase determinations. AP does not appear to behave differently when serum amylase is normal or elevated, and should therefore be submitted to similar therapeutic regimens in both conditions.read more
Citations
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American College of Gastroenterology guideline: management of acute pancreatitis.
TL;DR: As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography and/or magnetic resonance imaging of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically.
Journal ArticleDOI
A critical evaluation of laboratory tests in acute pancreatitis.
TL;DR: Once the diagnosis of AP is established, daily measurements of enzymes have no value in assessing the clinical progress of the patient or ultimate prognosis and should be discouraged.
Journal ArticleDOI
Assessing test accuracy and its clinical consequences: a primer for receiver operating characteristic curve analysis.
Journal ArticleDOI
Biochemical markers of acute pancreatitis
TL;DR: Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism, and genetic polymorphisms may play an important role in “idiopathic” acute recurrent pancreatitis.
Journal ArticleDOI
The syndrome of alcoholic ketoacidosis.
TL;DR: AKA is a common disorder in chronic malnourished alcoholic persons and reflects not only the ketoacidosis, but also associated extracellular fluid volume depletion, alcohol withdrawal, pain, sepsis, or severe liver disease.
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