Serum Amylase and Serum Lipase in the Diagnosis of Disease of the Pancreas

Comfort, Mandred W.; Osterberg, Arnold E.

doi:10.1016/s0025-7125(16)36690-1

Cited by 36 publications

(8 citation statements)

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“…Crandall (1935) and Lagerlof (1945) hold that the olive-oil-splitting esterase or lipase is normally confined to the pancreatic secretion and that it finds its way into the general circulation only when the gland becomes the seat of disease. Others believe that its presence in the blood is consistent with sound health (Comfort and Osterberg, 1940;Johnson andBockus, 1940, Wapshaw, 1948).…”

Section: Discussionmentioning

confidence: 98%

Pancreatic Side-effects of Morphine

Wapshaw¹

1953

BMJ

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Prior to the publication of Lagerlofs studies (1945, 1947), information regarding the influence of morphine on the pancreas was very fragmentary. In 1907 Bickel and Pincussohn observed in two dogs with pancreatic fistulae that it first decreased and later increased the output of the external secretion. Cohnheim and Modrakowski (1911), using dogs each with a duodenal and an ileal fistula, found that morphine depressed the natural response to food. Babkin (1928) also noted a diminution in the duodenal content after its administration to animals. A more remote effect, which has been reported in rabbits, is an inctease in the diastatic index of the urine (Sato, 1940).The first recorded studies in humans are by Lagerlof. Primarily interested in the fat-splitting enzymes in the blood, particularly those elaborated by the pancreas, he conceived that morphine might serve as a safe means of deranging the function of the gland. He compared the effect produced by the intravenous administration of purified secretin on the content of digestive ferments in the blood and duodenum with the effect of secretin given along with morphine. For the recovery of the duodenal juice he made use of the gastro-duodenal tube, thus minimizing the amount of gastric juice entering the duodenum. Secretin alone produced an abundant flow of pancreatic juice of high bicarbonate content unassociated with any appreciable change in the lipase levels in the blood. When it was given along with morphine there resulted a reduction in the volume of the duodenal fluid and a concomitant lowering of the secretory rates of amylase, trypsin, and, to a less extent, the bicarbonate of the pancreatic secretion: the amount of bilirubin in the duodenal contents was also diminished. These changes were maximal approximately 30 minutes after morphine. Soon afterwards there appeared in the blood a lipase that had not previously been present. Lagerlof interpreted these findings as being due to overaction of the sphincter of Oddi interfering with the delivery to the duodenum of the bile and pancreatic secretion, and leading to absorption of a portion of the latter into the blood stream. He could not, however, exclude altogether the possibility that morphine depresses the function of the pancreas. The procedure just outlined has come to be known as the morphine-secretin test, the focus of attention having shifted to the response on the part of the serum-enzymes (see below). Lagerlof has also made the arresting suggestion that the nausea and abdominal discomfort, sometimes amounting to pain, which not infrequently follow the administration of morphine, may be symptomatic of a drug-induced pancreatitis.This paper is principally concerned with the serumenzyme effects of morphine on healthy humans. Some were investigated in the fasting state, others were given a substantial meal before morphine, and in a third group an attempt was made to exalt the so-called vagus response of the pancreas to food by giving a parasympathetic stimulant before the morphine. Carbaminoylcholine ...

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Section: Discussionmentioning

confidence: 98%

Pancreatic Side-effects of Morphine

Wapshaw¹

1953

BMJ

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“…The determination of serum lipase has been shown to be of value in the diagnosis of pancreatic disease (4,5). Reasons for the lack of general clinical use are probably found not only in the technical difficulties of the methods, but also in the lack of specificity for lipase particularly with substrates other than olive oil.…”

Section: Discussionmentioning

confidence: 99%

“…A new method for the determination of serum esterase is also included. 4. Results with 50 normal sera and three abnormal sera are given.…”

Section: Discussionmentioning

confidence: 99%

“…Lipase is abundant almost exclusively in pancreas, preferentially hydrolyzes esters of long chain fatty acids and its activity is accelerated by sodium taurocholate (1)(2)(3). Although the measurement of serum esterase has not been demonstrated to be of clinical value, the measurement of serum lipase has been found to be useful in the diagnosis of pancreatic disease (4,5).…”

mentioning

confidence: 99%

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The Colorimetric Determination of Lipase and Esterase in Human Serum 1

Seligman¹,

Nachlas²

1950

J. Clin. Invest.

118

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“…In seven of these cases, a No. 3 Bakes dilator could not be passed; in six other patients, the No. 3 Bakes dilator could only be passed with difficulty.…”

Section: Treatmentmentioning

confidence: 96%