Elevated Serum Amylase Research Articles

Blood tests for acute pancreatitis.

The diagnosis of acute pancreatitis requires the presence of at least two of the three diagnostic criteria - characteristic abdominal pain, elevated serum amylase or lipase, and radiological evidence of pancreatitis. Serum concentrations of amylase and lipase rise within hours of the pancreatic injury. A threshold concentration 2-4 times the upper limit of normal is recommended for diagnosis. Serum lipase is now the preferred test due to its improved sensitivity, particularly in alcohol-induced pancreatitis. Its prolonged elevation creates a wider diagnostic window than amylase. Neither enzyme is useful in monitoring or predicting the severity of an episode of pancreatitis in adults. New biomarkers including trypsinogen and elastase have no significant advantage over amylase or lipase.

Reg3g Promotes Pancreatic Carcinogenesis in a Murine Model of Chronic Pancreatitis.

Regenerating islet-derived 3 (Reg3) is abnormally expressed in several human digestive system diseases, including chronic pancreatitis (CP) and pancreatic cancer (PC). The purpose of this study was to clarify the mechanism of the enhanced expression of Reg3 in inflammation-induced PC. C57BL/6 mice were treated with caerulein for 6 weeks to induce CP and then injected with pReg3g--a lentivirus system encoding for murine Reg3g--accompanied by dimethylbenzanthracene to induce PC. We detected pancreatic histopathological characteristics, tumor-related gene expression, inflammation-associated pathway activation, serum biochemical indicators, and immunological cell activities. The mice that developed CP after caerulein treatment were marked by pronounced histologic lesions, elevated serum amylase levels, and activation of inflammation-related pathways. Mice given a high dose of pReg3g developed PC by 16 weeks, with recognizable tumors in the pancreas. While, both the low and high doses of pReg3g produced higher transcription of c-fos, k-ras, cytokeratin-19, and proliferating cell nuclear antigen, and a lower expression of caspase-3 compared to pNEG controls. Additionally, the higher dose of pReg3g increased the expressions of pSTAT3, NFκB (p65), and SOCS3 methylation during PC development. In addition, mice treated with pReg3g displayed higher levels of serum IL10 and TGFβ and suppressed T lymphocyte proliferation and DC function. The comprehensive analysis suggests enhanced Reg3g expression exacerbates PC in inflammation-associated cancer progression. Reg3g appears to promote CP-related PC in mice through multiple mechanisms, involving enhanced transcription of pancreatic tumor markers, repression of anti-tumor immunity, and activation of STAT3/p65 signal transduction pathways.

Macroamylasemia; a Dilemma in Morbidity.

To the Editor, A one-year-old boy was referred for randomly detected hyperamylasemia. Physical examination was completely normal, including growth parameters. Medical history and family history were unremarkable. In laboratory, the repeated serum amylases were found elevated with the values of 280 IU/mL, 290 IU/mL and 310 IU/mL (N: 10–90 IU/mL) together with a lower urine amylase level of 10.5 IU/mL (N: 25–500 IU/mL). The complete blood count, acute-phase reactants, liver–renal–thyroid functional tests, serum lipase and immunoglobulins were normal. Antibodies against endomysium, gliadin, thyroglobulin, thyroid peroxidase, nucleus and dsDNA were negative. Abdominal ultrasonography and computed tomography (CT) scans were normal. According to these normal findings, hyperamylasemia due to macroamylasemia (MA) was found in patient. An informed consent form to research was obtained from parents. At analysis for MA, a precipitated activity was 87% at polyethylene glycol (PEG) precipitation (MA>60%) (1). Macroenzymes are complexes of serum enzymes commonly with immunoglobulins or lipoproteins that have a higher moleculer weight. Macroamylase is the most common macroenzyme, in which pancreatic or salivary amylase binds to plasma proteins and cannot be excreted by renal glomeruli. Macroamylasemia may be seen either isolated or associated with a variety of disorders, such as IgA deficiency, celiac disease, lymphoma, carcinoma, systemic lupus erithematosus, rheumatoid arthritis, liver disease and various autoimmune diseases (2–4). The pathogenesis of macroenzyme formation in these diseases is estimated by ‘antigen-driven’ theory: a self-antigen is altered or released from a sequestered site in the body and cross-reacts with an antibody initially formed against a foreign antigen. A second theory is the ‘dysregulation of immune tolerance, which is likely to occur in autoimmune disorders (4). The cross-reactivity to either gluten-related or other antigens resulting in autoantibody formation against pancreatic serum amylase at intestinal level is considered (5). The elevated serum amylase, low 24-hour urine amylase and reduced ratio of amylase clearance / creatinine clearance are important at diagnosis. It has been shown that PEG precipitation is also a precise method in the detection of MA by purifying protein from macromolecules more easily and quickly (1). Due to the problem at urine collection, PEG precipitation was preferred in this case. It was considered as isolated MA due to the absence of associated disorders. In conclusion, MA is generally a benign condition, but associated potential disorders should be considered at follow-up. The case highlights the dilemma of additional invasive explorations and unnecessary treatments by differentiating MA from other situations associated to hyperamylasemia.

Unusual Presentation of Unusual Pancreatic Tumors

Unusual pancreatic tumors described here are other than the common pancreatic tumor like cystic neoplasms of pancreas and functioning pancreatic neuroendocrine tumors. They are called unusual because they are diagnosed rarely and with a deviated unusual presentation instead of literature-described common presentation. Here we describe two rare pancreatic tumors with rarest presentation. We reviewed our data retrospectively for unusual pancreatic tumors, other than adenocarcinoma, about their presentation and management. Out of 19 unusual cases we found two cases with rarest presentation, one is a solid pseudo papillary tumor presenting like pancreatitis and the other is MEN 1 syndrome presenting with renal failure and cerebrovascular accident due to pancreatic VIPOMA. Case 1: A 22-year-old female presented with 25 episodes of diarrhea and weakness of right upper extremity. She went into acute renal failure and MRI brain showing acute infarct in the middle cerebral artery territory due to very severe dehydration. On evaluation found to be VIPOMA and Parathyroid adenoma. Case 2: A 29-year-old female presented with pain in the upper abdomen and vomiting. Her labs showed more than three times elevated serum amylase and lipase and an ultrasound of the abdomen shows peri pancreatic acute fluid collection. On evaluation, it is found to be Frantz tumor with pancreatitis. A review of literature showed less than 1% association of VIPOMA with MEN1 syndrome and presenting with cerebrovascular accident was very rare. Frantz tumor presenting like pancreatitis is never reported. Hence such rare presentations are reported here to be aware of such clinical scenarios.

PTU-055 Hyperamylasaemia and acute pancreatitis after double balloon enteroscopy: a prospective study: Abstract PTU-055 Table 1

Introduction Hyperamylasaemia and acute pancreatitis are potential complications following a double balloon enteroscopy (DBE) procedure. The mechanism of these complications is not fully understood. We present a prospective analysis of all patients undergoing DBE at a tertiary centre. Method Single centre, prospective study involving all consecutive patients attending for DBE by either route, between 23 rd Aug 2012 and 3 rd October 2014. Serum amylase levels were obtained before and three hours after the procedure. Clinical evaluation for signs and symptoms of pancreatitis was performed three hours after the procedure. A record of the procedure duration, insertion depth and number of passes was also documented. Hyperamylasaemia was defined as an elevation of the serum amylase level to greater than the upper limit of normal. Results 115 procedures were performed on 89 patients, mean age 57.4 years (21–83 years), 46 male (51.7%). Indication for procedure is presented in Table 1. 91 procedures were performed per orally and 24 via the anal route. 88 procedures were performed on the basis of a positive small bowel capsule endoscopy (SBCE), 9 patients did not have prior SBCE due to failure to excrete the patency capsule. Indication for DBE is presented in Table 1. Overall 47 patients (61%) had an elevated serum amylase post procedure. Hyperamylasaemia post-procedure was observed in significantly more patients following per-oral DBE compared to DBE via the anal route (p = 0.03). Hyperamylasaemia in the per-oral group was associated with procedure depth (mean 147 cm vs 187 cm p Conclusion Hyperamylasaemia is common following DBE per-orally and is associated with procedure depth and number of passes. However, in the majority of cases this is of limited clinical significance and no patients in our series went on to develop pancreatitis. Disclosure of interest None Declared.

An Unusual Cause of Abdominal Pain in an Elderly Woman

Department of Radiodiagnosis and Imaging and Department of Gastroenterology, Postgraduate Institute of MedicalEducation and Research (PGIMER), Chandigarh, IndiaQuestion: A 70-year-old woman presentedwith acute epigastricpain radiating to theback associated withdifficulty in breathing.There were few epi-sodes of vomiting overthe last 2 days. Therewas no associated feveror jaundice. No similarepisodeshadbeenre-ported previously.On examination,there was mild pallor.No icterus was present.Abdominal examina-tion revealed mild tenderness in the epigastrium. Other findings on systemic examination were a dull note on the left side ofchest with added sounds on auscultation. Total (1.8 mg/dL) and direct bilirubin (1.2 mg/dL) were mildly elevated. Routinehematologic investigations were unremarkable except for mild anemia (10 g/dL). There was elevation of serum amylase(660 IU/L). A diagnosis of acute pancreatitis was considered. Abdominal ultrasonography failed to visualize the pancreas.However, there were no gallstones. Other workup for acute pancreatitis, including history of alcohol/ drug intake, lipidprofile, and serum calcium, was negative.Contrast-enhanced multidetector (MD)CT of the abdomen revealed bulky pancreas (Figure A, B, arrows) in an abnormalposition. Similarly, the collapsed stomach (Figure A, short arrows) and spleen (Figure A, B, arrow head) was found in anabnormal position. The superior mesenteric artery (Figure A, thin arrow) showed an abnormal orientation. There was milddilatation of the common bile duct (Figure B, long thin arrow) and the main pancreatic duct (Figure B, long thick arrow).What is your diagnosis?See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favoriteimage to Clinical Challenges and Images in GI.

Misdiagnosis of macroamylasemia in pregnancy as pancreatitis

Abstract Background: While elevated serum amylase in the presence of abdominal pain can be indicative of pancreatitis, differential diagnosis of macroamylasemia depends on additional assessment of serum lipase and urinary amylase. The present report concerns misdiagnosis of pancreatitis in a pregnant woman with elevated serum amylase but normal lipase. Highlights: The patient was a nulligravid woman on her first pregnancy diagnosed with pancreatitis in her 32nd week plus 3 days of gestation, on the basis of elevated serum amylase and abdominal pain, after treatment for premature contractions and antepartum vaginal bleeding with ritodrine HCl and nifedipine. She was started on painful and invasive intravenous hydration; oral intake was stopped. Repeat elevated serum amylase suggested that the patient might in fact have macroamylasemia, not pancreatitis. Conclusions: Normal serum lipase levels should be considered as a likely indication of an alternative cause of elevated serum amylase to pancreatitis, and urinary amylase should be routinely checked to assist in differential diagnosis to avoid unnecessary and invasive treatment and stress to pregnant women.

Acute pancreatitis complicated by jejunal hematoma in a patient on anti-coagulants and anti-platelets.

Pancreatitis can be associated with significant complications. Bowel hematoma is a rare complication and the second part of the duodenum is the most commonly affected site. Hematomas affecting other parts of the bowel are extremely rare. A 53-year-old female with a history of atrial fibrillation and ischemic heart disease on anticoagulants and aspirin presented with abdominal pain of a few days duration which had worsened prior to presentation. This was associated with abdominal distension, vomiting and melena. Laboratory investigations showed elevated serum amylase, coagulopathy and severe anemia. Computed tomography imaging showed a jejunal hematoma and pancreatitis with peripancreatic inflammation. She responded to conservative treatment in addition to correction of the coagulopathy and a blood transfusion. Her symptoms were resolved within a few days and a repeat computed tomography scan two months later showed complete resolution of the hematoma and the pancreatitis. Our case demonstrates a rare complication of acute pancreatitis in a patient with risk factors.

Nonspecific hyperamylasemia: a case report.

The elevation of serum amylase and lipase are generally associated with pancreatic diseases. However they can be associated with different pathologies unrelated with amylase and lipase. This paper aims to report a case of a patient diagnosed with nonspecific hyperamylasemia and warn of this possibility in the differentiation of hyperamylasemia. The correct diagnosis of silent hyperamylasemia is important in order to determine whether there is the risk of pancreatic disease or if we are just ahead of a benign hyperenzymemia.

Continuous regional arterial infusion for the treatment of severe acute pancreatitis: a meta-analysis

Continuous regional arterial infusion (CRAI) is a drug delivery system, which dramatically increases the drug concentration in the pancreas. Previous clinical and basic studies have demonstrated the possible therapeutic efficacy of CRAI for severe acute pancreatitis (SAP). This meta-analysis of all published randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of CRAI for the treatment of SAP. Up to August 10, 2014, RCTs comparing CRAI with intravenous infusion for SAP in PubMed, Embase, EBSCO, MEDLINE, Science Citation Index Expanded, Cochrane Library, China Academic Journals Full-Text Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database were selected by two independent reviewers. The relative risk (RR) and their 95% confidence intervals (CI) for duration of elevated serum amylase and urine amylase, duration of abdominal pain, infection rate, incidence of complication, overall mortality, curative rate, hospital stay and details of subgroup analysis were extracted. Meta-analyses were made using the software Review Manager (RevMan version 5.10). Six RCTs with 390 patients meeting the inclusion criteria were included in the final analysis. Compared with intravenous infusion route, CRAI significantly shortened the duration of elevated urine amylase (MD=-2.40, 95% CI=-3.20, -1.60; P<0.00001) and the duration of abdominal pain (MD=-1.46, 95% CI=-1.94, -0.98; P<0.00001), decreased the incidence of complication (RR=0.35, 95% CI=0.15, 0.81; P=0.01) and overall mortality (RR=0.25, 95% CI=0.08, 0.78; P=0.02), shortened the duration of hospital stay (MD=-10.36, 95% CI=-17.05, -3.68; P=0.002), and increased the curative rate (RR=1.66, 95% CI=1.13, 2.46; P=0.01). No mortality and catheter-related infections due to CRAI administration was reported in these studies. Subgroup analysis showed that the combination of drug administration via CRAI did not significantly improve the outcomes. CRAI is effective for the treatment of SAP, and the combination of drug administration via CRAI did not have a significant effect on the improvement of the outcomes.

A Rare Case of Pancreatitis, Panniculitis and Polyarthritis: The P-P-P Syndrome

A 70-year-old man was admitted to our Unit because of the onset of symmetric joint pain, and multiple cutaneous erythematous nodules localized to the lower extremities and gluteal region. An arthrocentesis excluded a septic arthritis and systemic and local steroid therapy resulted in a modest improvement of symptoms and cutaneous manifestations. For an acute abdominal pain with an elevation of serum amylase and lipase levels, the patient underwent an abdominal CT that showed a 55 mm roundish mass in the head of the pancreas with necrosis and colliquation, associated with dilatation of the main pancratic duct and thrombosis of the superior mesenteric vein. The pancreatic lesion was biopsied during an endoscopic ultrasonography and the histopathological examination documented a chronic obstructive pancreatitis. Taken together, the clinical manifestations shown by this case highlighted a rare condition referred to as “PPP (i.e. pancratitis, panniculitis, polyarthritis) syndrome” which links pancreatitis to extrapancreatic tissue involvement.

Transient Macroamylasemia in a Severely Multiple-Handicapped Child Following the Development of Acute Bronchitis

Macroamylasemia is a condition of elevated serum amylase levels in which normal serum amylase form a complex with high molecular weight proteins such as immunoglobulins. This is a case report on a patient with macroamylasemia following acute asthmatic bronchitis. A 5-year-old male with cerebral palsy and developmental retardation was admitted to our hospital because of high fever and severe cough. Treatment of the respiratory symptoms provided symptomatic improvement, but the serum amylase levels became suddenly elevated. Although acute pancreatitis associated with respiratory infection was initially suspected, a predominant salivary isoamylase, normal serum lipase level, low urine amylase level, and low amylase-creatinine clearance ratio (ACCR) (0.58%) indicated macroamylasemia. The serum amylase level decreased, and the ACCR increased within normal range 2 weeks after discharge. Both of these indicators have been within normal range over the past year. Transient macroamylasemia can be misdiagnosed as acute pancreatitis, especially in a severely multiple-handicapped child who is unable to complain. The ACCR is useful in the diagnosis of macroamylasemia.

Hypertriglyceridemia-Induced Pancreatitis in Poorly Controlled Type 2 Diabetes

A 38-year-old female presented with abdominal pain, radiating to her back. Her medical history included type 2 diabetes, which had been uncontrolled for 8 months. Her initial laboratory tests showed marked hyperglycemia, metabolic acidosis, and elevated serum amylase and lipase levels, although the results were inconclusive in terms of a direct diagnosis of acute pancreatitis (AP). Abdominal computed tomography showed only minimal fluid collection at the pancreas tail. As her serum triglyceride (TG) level was 9,884 mg/dL, we made a working diagnosis of AP due to hypertriglyceridemia, and she was treated with massive hydration with an insulin infusion. Subsequently, she recovered rapidly from the abdominal pain, her serum glucose was controlled, and her serum TG decreased. Hypertriglyceridemia is a well-accepted underlying cause of AP. When extremely high hypertriglyceridemia is detected in patients with type 2 diabetes or metabolic syndrome, complications should be considered and managed.

Intramuscular diclofenac for the prevention of post-ERCP pancreatitis: a randomized trial.

Rectal nonsteroidal anti-inflammatory drugs have been shown to reduce the incidence of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The aim of this study was to determine whether intramuscular diclofenac reduces the risk of PEP. Patients who underwent ERCP were randomized to receive either 90 mg of diclofenac or placebo by intramuscular injection immediately after the procedure. PEP was defined as elevated serum amylase levels (at least three times the upper limit of normal 24 hours after the procedure) associated with new or worsened upper abdominal, epigastric, or back pain. In total, 380 patients were randomized, and 343 were eligible for analysis. The two groups were similar regarding clinical and demographic factors, as well as patient- and procedure-related risk factors for PEP. PEP developed in 20/170 patients (11.8 %) in the placebo group and in 22/173 patients (12.7 %) in the diclofenac group (P = 0.87). Multivariate regression analysis failed to illustrate that intramuscular diclofenac prevented PEP (odds ratio 0.79; 95 % confidence interval 0.39 - 1.25; P = 0.51). Prophylactic intramuscular diclofenac had no beneficial preventive effect on PEP.Clinicaltrials.gov NCT01717599.

English

Venous thrombosis and hypercoagulable state has been described in patients with acute and chronic pancreatitis. Though this is commonly observed in splanchnic vessels, thrombosis of IVC is not frequently encountered. 1 CASE REPORT: A 32years old male with alcoholic pancreatitis with previous episode of acute pancreatitis three months ago, presented to us with acute abdomen. Examination of the abdomen revealed a 8x15cms mass in left upper quadrant extending into right upper quadrant, non-mobile, not moving with respiration, mildly tender and dull on percussion. Investigations revealed mildly elevated serum and urinary amylase. CT abdomen revealed pseudocyst pancreas measuring 8x16cms pushing stomach anterolaterally, extending anteriorly up to anterior abdominal wall with features consistent of chronic pancreatitis. An unusual finding was large intraluminal thrombus within IVC extending up to confluence of iliac veins. The patient did not have lower limb edema or abdominal collaterals despite involvement of intra-abdominal IVC. DISCUSSION: Vascular complications in pancreatitis are well documented. Acute pancreatitis has also found to generate thrombosis of the inferior vena cava. 2,3 The pathogenesis of IVC thrombosis in pancreatitis is not well understood, but the contributing factors could be-inflammation, edema and cellular infiltration adjacent to IVC, hypercoagulable state, mass effect and compression due to pseudocyst and bulky pancreas, intimal injury caused by pancreas.4 Although inferior vena cava thrombosis in the setting of pancreatitis is rare, this clinical entity may account for an unexplained deterioration in the status of a patient with pancreatitis. And this can be effectively treated with anticoagulation and hence mortality related to complication such as pulmonary embolism can be prevented.5

PTH-015 Post-ercp Pancreatitis In Secondary Care: Can We Predict Who Would Benefit From A Prophylactic Pancreatic Stent?

IntroductionPancreatitis is a recognised complication of ERCP. Measures taken to reduce the incidence in high-risk patients include placement of prophylactic pancreatic stents and use of NSAIDs, but current practice varies...

ABSTRACT 256

Background and aims: Thrombocytopenia following DKA is a rare complication with several possible aetiologies, each with distinctive approaches to management. Aims: Case report and discussion. Methods: A 9-year-old girl presented to the emergency department with a reduced level of consciousness. This was the first presentation of severe DKA in a newly diagnosed diabetic. She was profoundly acidotic (pH 6.83, pCO2 1.99, HCO3 4.7, BE -31.6, glucose 33) and urine was positive for glucose/ketones. Within 12 hours of admission she developed thrombocytopenia (lowest platelet count 31 x 10^6), progressively deteriorating renal function, and a raised amylase. Written consent was obtained from the patient’s family for publication. Results: Differential diagnoses of: haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura (TTP), and/or sepsis were considered. Blood film showed no evidence of haemolysis and the ADAMTS 13 (A Disintegrin and Metalloprotease with ThromobSpondin motifs; formerly known as von Willebrand factor cleaving-protease) activity was within the normal range, excluding TTP with associated microangiopathic haemolytic anaemia. Conclusions: The specific combination of renal failure, thrombocytopenia and pancreatic enzyme elevation is rare following paediatric DKA (in contrast to elevated serum urea, creatinine and amylase; which are relatively common). We have only identified 3 case reports. A key factor is to exclude one of the microangiopathic syndromes (TTP, disseminated intravascular coagulation, thrombotic microangiopathy) associated with low ADAMTS 13 activity and significant mortality. These conditions require urgent plasma exchange to remove ADAMTS 13 inhibitors and dramatically reduce mortality. In our case no such treatment was necessary, and the patient made a full recovery with supportive therapy alone.

Clinical features of and therapeutic ERCP for 1 158 patients with pancreatobiUary diseases

Objective To evaluate the clinical features of pancreatobiliary diseases and the strate- gies of therapeutic ERCP for patients over 80 years. Methods Data of 1 158 patients over 80 years with pancreatobiliary diseases, who received ERCP from January 2007 to June 2013, were retrospectively ana- lyzed. Results A total of 1 315 procedures were performed in 1 158 patients, with a success rate of 98.5% （1 295/1 315）. After ERCP, cholangiolithiasis was diagnosed in 554 （47. 8% ） patients, malignant ob- struction of biliary tract in 494 （42. 7% ）, benign stenosis of bile duct in 42 （3.6%）, Mirrizi syndrome in 23 （2. 0% ）, stone of pancreatic duct in21 （1.8%） and normal in24 （2. 1% ）. The post-ERCP complica- tions included pancreatitis in 67 （ 6. 5% ）, elevated serum amylase in 156 （ 13.5% ） and death in 5 （0. 4% ）. Conclusion Therapeutic ERCP is safe and effective for extremely elderly patients with pancre- atobiliary diseases. Key words: Cholangiopancreatography, endoscopic retrograde; Elderly patients; Pancreatobiliary diseases

Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: A prospective study with systematic review

IntroductionReliability of serum pancreatic enzyme levels in predicting pancreatic injuries has been a parameter of interest and the present recommendations on its utility are based primarily on anecdotal observations. The aim of this study was to evaluate the utility of serum pancreatic enzyme assessment in predicting blunt pancreatic injury with imaging and surgical correlation and compare our results with a systematic review of literature till date. MethodsA prospective cohort study conducted over 4 years in a tertiary care referral centre with 164 consecutive patients who presented to the emergency department with a history of blunt abdominal trauma and had serum pancreatic enzyme assessment, USG and subsequent diagnostic CECT were analyzed. The CT findings and AAST grade of pancreatic injury, various intra-abdominal injuries and time elapsed since injury and other associated factors were correlated with serum pancreatic enzyme levels. For systematic review of literature MEDLINE database was searched between 1940 and 2012, also the related citations and bibliographies of relevant articles were analyzed and 40 articles were included for review. We compared our results with the systematic critique of literature till date to formulate recommendations. Results33(21%) patients had pancreatic injury documented on CT and were graded according to AAST. Statistically significant elevated serum amylase levels were observed in patients with pancreatic and bowel injuries. However, elevated serum lipase was observed specifically in patients with pancreatic injury with or without bowel injury. Combined serum amylase and lipase showed 100% specificity, 85% sensitivity in predicting pancreatic injury. Elevated (n=28, 85%) vs. normal (n=5, 15%) serum amylase and lipase levels showed sole statistically significant association with time elapse since injury to admission, with a cutoff of 3h. ConclusionsBased on our results and the systematic review of the literature till date we conclude, persistently elevated or rising combined estimation of serum amylase and lipase levels are reliable indicators of pancreatic injury and is time dependent, nondiagnostic within 6h or less after trauma. In resource constrained countries where CT is not available everywhere it may support a clinical suspicion of pancreatic injury and can be reliable and cost-effective as a screening tool.

Elevated serum amylase in patients with chronic pancreatitis: Acute attack or macroamylasemia?

Background and aimAsymptomatic patients with chronic pancreatitis not infrequently have elevated concentrations of amylase, even though detailed examination reveals no indication of an acute exacerbation. MethodsOne hundred and eighty-six consecutive patients with chronic pancreatitis were examined clinically and, if indicated, by ultrasonography and computed tomography. In addition, all patients underwent determination of serum amylase and serum lipase as well as amylase/creatinine clearance, followed as required by a polyethylene glycol test and/or chromatography to demonstrate macroamylase. ResultsTwenty (11%) of the 186 patients had macroamylasemia, and 15 of these 20 had hyperamylasemia. In the remaining five cases the serum amylase levels were within the normal range. ConclusionsPatients with asymptomatic chronic pancreatitis and hyperamylasemia should first be investigated for macroamylasemia, before initiating any costly or complex procedures in the attempt to demonstrate a clinically silent or only mildly symptomatic attack of their disease.