The pathologic significance of the serum amylase concentration; an evaluation with special reference to pancreatitis and biliary lithiasis.

Abstract

Since the introduction of the serum amylase test by Somogyi1and others, the discovery of an elevated serum amylase has usually been interpreted as conclusive evidence of the existence of severe inflammatory disease of the pancreas. The diagnosis of acute pancreatitis is now based much more frequently on examination of the blood serum than upon the actual examination of the pancreas; while before the introduction of the amylase test, the diagnosis of pancreatitis was made solely upon the actual discovery of the abnormality during celiotomy or autopsy. Since the amylase test has seemed to offer a sure way of making the diagnosis of pancreatitis without operation, the so-called conservative treatment has become standard practice. Actually the presence of acute pancreatitis and its possible severity must remain in doubt as long as the diagnosis is substantiated only by an elevation of the serum amylase despite the presence of what seem