Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis

Rompianesi, Gianluca; Hann, Angus; Komolafe, Oluyemi; Pereira, Stephen P.; Davidson, Brian R; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd012010.pub2

Cited by 72 publications

(79 citation statements)

References 238 publications

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“…Klinička prezentacija akutnog abdominalnog bola i nalazi dobiveni laboratorijskom dijagnostikom te slikovnim pretragama ukazivali su na nejasnu etiologiju bolova kod našeg pacijenta. Diferencijalno dijagnostički sumnjalo se na akutni pankreatitis, međutim, vrijednosti alfa amilaze u serumu su bile samo neznatno povišene, dok su kod pacijenata s akutnim pankreatitisom one tri puta veće od gornje granice referentnih vrijednosti 6 . CT nalaz je tek četvrtog dana hospitalizacije prikazao trombozu splanhničkih vena.…”

Section: Raspravaunclassified

Tromboza splanhničkih vena kao rijedak uzrok akutnog abdominalnog bola

Rumora

Milić

2019

Med. Flum. (Online)

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Sažetak. Cilj:Prikazati slučaj pacijenta s akutnim abdominalnim bolom kojemu je dijagnosticirana tromboza splanhničkog venskog sustava, a uzrok je naknadno dokazana mijeloproliferativna bolest uz JAK2 V617F varijantu sekvence. Prikaz slučaja: 44-godišnji pacijent primljen je u hitnu medicinsku službu zbog akutizacije paraumbilikalnog bola koji je trajao 10-ak dana. U laboratorijskim nalazima bile su povišene vrijednosti alfa amilaze i upalnih parametara, zbog čega je pacijent hospitaliziran. Nativna snimka abdomena i ultrazvuk abdomena pokazivali su meteorizam tankog i debelog crijeva. Zbog nejasne dijagnoze učinjena je i kompjutorizirana tomografija (CT) abdomena koja je pokazala samo zamućeno mezenterijalno masno tkivo u korijenu mezenterija. Trećeg dana hospitalizacije zbog intenzivnijih bolova, koji nisu popustili ni na opiodne analgetike, učinjen je kontrolni CT abdomena koji je pokazivao trombozu v. portae, v. mesentericae superior i v. lienalis. Navedene promjene bile su praćene zadebljanjem stijenke tankog crijeva u smislu kongestije i raslojavanja stijenke, ali bez znakova jasne ishemije, te parcijalnim poremećajima perfuzije jetre uz prisutnost ascitesa. U terapiju je uveden niskomolekularni heparin u punoj dozi uz acetilsalicilnu kiselinu, a zbog dodatnog pogoršanja stanja sa znakovima paralitičkog ileusa i progresijom ishemijskih promjena tankog crijeva učinjena je hitna laparotomija. Za vrijeme hospitalizacije, hematološkom obradom dokazana je JAK2 V617F varijanta sekvence i mijeloproliferativna bolest koja je etiološki čimbenik tromboze portalnog sustava i ishemije crijeva. Zaključak: Uzrok akutnog bola u trbuhu može rijetko biti i tromboza splahničkog sustava, koja u kratkom vremenskom periodu može dovesti do životno ugrožavajućeg stanja. Akutno nastalu trombozu splanhničkog venskog sustava nužno je liječiti antikoagulantnom terapijom, a ako taj način liječenja ne pokaže zadovoljavajuće rezultate, nužan je kirurški zahvat. Dokazana mijeloproliferativna bolest uz JAK2 V617F varijantu sekvence mogući je etiološki čimbenik splanhničke venske tromboze kod mlađih pacijenata.Ključne riječi: abdominalni bol; infarkt crijeva; JAK2 V617F varijanta sekvence; tromboza splanhničkog venskog sustava Abstract. Aim: To present a patient with acute abdominal pain diagnosed with acute thrombosis of the splannchnic vein system and subsequently diagnosed myeloproliferative disease and JAK2 V617F sequence variant. Case report: A 44-year-old patient was admitted to an emergency medical tract due to the acutization of paraumbilical abdominal pain that was present for 10 days, with mild intensity. In the laboratory findings, elevated values of alpha amylase and inflammatory parameters were elevated, wherefor patient was hospitalized. Native abdominal radiograph and abdominal ultrasound showed meteorism of the small intestine and colone. Due to unclear diagnosis, computerized tomography (CT) of the abdomen was performed, which showed blurred mesenterial fatty tissue at the mesenteric root. On the third day of hospitalizati...

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Section: Raspravaunclassified

Tromboza splanhničkih vena kao rijedak uzrok akutnog abdominalnog bola

Rumora

Milić

2019

Med. Flum. (Online)

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“…In pancreatitis lipase and amylase tend to rise within the first few hours of symptom onset, with lipase remaining elevated for longer than amylase levels. 61 It is important to note that in up to 25% of cases serum amylase or lipase levels will not be elevated, necessitating need to consider imaging studies if the clinical presentation is suggestive of pancreatitis. 61 In our review, clozapine associated pancreatitis had a shorter duration of recovery (15.7 days) compared to hepatitis and nephritis cases.…”

Section: Clozapine Associated Pancreatitismentioning

confidence: 99%

“…61 It is important to note that in up to 25% of cases serum amylase or lipase levels will not be elevated, necessitating need to consider imaging studies if the clinical presentation is suggestive of pancreatitis. 61 In our review, clozapine associated pancreatitis had a shorter duration of recovery (15.7 days) compared to hepatitis and nephritis cases. A Swedish Nationwide database study identified an increased risk of pancreatitis with antipsychotic use, though this was not increased with clozapine or olanzapine use (OR 0.9 (0.6-1.4).…”

Section: Clozapine Associated Pancreatitismentioning

confidence: 99%

Hepatitis, Interstitial Nephritis, and Pancreatitis in Association With Clozapine Treatment

Lally¹,

Kalbani

Krivoy³

et al. 2018

J Clin Psychopharmacol

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Clozapine-induced hepatitis, nephritis, and pancreatitis are uncommon adverse events, reflected in the paucity of case studies in the literature. Early recognition of the signs and symptoms of clozapine-associated hepatitis, nephritis, and pancreatitis is important, as when identified, clozapine should be urgently discontinued. Clozapine is associated with evidence of benign inflammatory processes; the extent to which hepatitis, and other inflammatory reactions, may be on a continuum with these more benign and self-limiting reactions is unclear, and this can only be resolved by prospectively following cohorts of clozapine-treated patients.

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“…The diagnostic value of serum lipase and amylase in acute pancreatitis is unclear. Approximately 10% of patients may be incorrectly diagnosed with acute pancreatitis because of non-specific elevations in pancreatic enzymes [98]. A recent Cochrane review assessed the diagnostic accuracy of index pancreatic enzyme levels in patients who presented to the emergency department with abdominal pain.…”

Section: Cause and Risk Factorsmentioning

confidence: 99%

“…This could be partially related to delayed presentation for medical evaluation because of short half-life of serum amylase and lipase [99]. Among 100 patients with lipase and amylase levels less than three times the upper limit of normal, only 68 and 74 patients had acute pancreatitis, respectively [98]. There are many other causes of elevated lipase that could be misdiagnosed as acute pancreatitis [100].…”

Section: Cause and Risk Factorsmentioning

confidence: 99%

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

Faghih

González

Makary³

et al. 2017

Current Opinion in Gastroenterology

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Purpose of review Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. Recent findings The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. Summary The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery.

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Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis

Cited by 72 publications

References 238 publications

Tromboza splanhničkih vena kao rijedak uzrok akutnog abdominalnog bola

Tromboza splanhničkih vena kao rijedak uzrok akutnog abdominalnog bola

Hepatitis, Interstitial Nephritis, and Pancreatitis in Association With Clozapine Treatment

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

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