Serum amylase isoenzyme alterations in acute abdominal conditions

Swensson, Erik E.; King, Mary E.; Malekpour, Afsaneh; Maull, Kimball I.

doi:10.1016/s0196-0644(85)80285-7

Cited by 10 publications

(3 citation statements)

References 9 publications

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“…The blood P-amylase level is considered useful in the differential diagnosis of hyperamylasemia, and, while one report claimed it could identify 83% of patients (19/ 23) with hyperamylasemia independent of pancreatic disease (Level 4), 24 others suggest a capability of only 20% to 44% (Levels 3b-4). 16,19 There is a report describing the blood P-amylase level as a useful indicator, because the abnormally high level is maintained for longer than are the abnormal blood amylase levels in acute pancreatitis (Levels 3b), 25 but another report showed that the blood P-amylase level did not improve sensitivity or specificity (Level 2b).…”

Section: P-amylase (Amylase Isozyme)mentioning

confidence: 99%

JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis

Koizumi

Takada

Kawarada

et al. 2006

J Hepatobiliary Pancreat Surg

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-Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected acute pancreatitis. -Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing acute pancreatitis and its intraperitoneal complications. -Computed tomography (CT) is also one of the most important imaging procedures for diagnosing acute pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of acute pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the pancreatitis is unknown. -When acute pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by acute pancreatitis are present. -Because the etiology of acute pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced acute pancreatitis, which requires treatment of the biliary system, and alcohol-induced acute pancreatitis, which requires a different form of treatment. Key words AbstractThe currently used diagnostic criteria for acute pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with acute pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of acute pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations:-Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of acute pancreatitis and its differentiation from other diseases. -A pivotal factor in the diagnosis of acute pancreatitis is identifying an increase in pancreatic enzymes in the blood.

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Section: P-amylase (Amylase Isozyme)mentioning

confidence: 99%

JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis

Koizumi

Takada

Kawarada

et al. 2006

J Hepatobiliary Pancreat Surg

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“…There is a study reporting that, by measuring the blood p ‐amylase level, a differential diagnosis of hyperamylasemia not associated with pancreatic diseases was made in 83% (19/23 cases) of patients with hyperamylasemia (Level 4) [40]. On the other hand, there are reports showing that the differential ability of measurements of blood p ‐amylase was 20–44% (Level 3b) [11, 13].…”

Section: Introductionmentioning

confidence: 99%

New diagnostic criteria of acute pancreatitis

Kiriyama

Gabata

Takada

et al. 2009

J Hepato Biliary Pancreat

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Practical guidelines for the diagnosis of acute pancreatitis are presented so that a rapid and adequate diagnosis can be made. When acute pancreatitis is suspected in patients with acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of acute pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other acute abdominal diseases are ruled out if local findings associated with pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having acute pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting acute pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of acute pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of acute pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of acute pancreatitis. Elucidation of the etiology of acute pancreatitis should be continued after a diagnosis of acute pancreatitis. In the process of the etiologic elucidation of acute pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced acute pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US.

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“…However, another study using independent criteria to classify the study subjects found similar specificity of the pancreatic isoenzyme and total amylase measurements (22). Several other studies have examined the isoenzyme content of specimens from patients chosen for study because of an elevated total amylase activity, and all concluded that pancreatic amylase determinations were helpful in excluding false-positive amylase elevations due to nonpancreatic disease (23)(24)(25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Rapid measurement of serum pancreatic amylase

Landt

Hortin

Smith

et al. 1994

Clinical Laboratory Analysis

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A simple, rapid assay for the pancreatic isoenzyme of human serum amylase was developed. The assay utilized an immunoabsorbent prepared by coating latex beads with a monoclonal antibody specific for pancreatic amylase. Treatment of patient serum with immunoabsorbent removed pancreatic amylase, and measurement of residual amylase activity with standard total amylase methodology allowed estimation of the pancreatic amylase content. Extraction efficiency of pancreatic amylase was consistent at amylase concentrations up to 1,000 U/L (y = 0.97 x +16.7 U/L; r = 0.9995). The assay was standardized with purified pancreatic amylase added to neonatal serum (low endogenous activity). A comparison of patient specimen results with the results of a standard technique (cellulose acetate electrophoresis) yielded an excellent correlation (immunoabsorption result = 0.96 electrophoresis result + 1.2 U/L; r = 0.987). Salivary amylase did not interfere with the assay until levels exceeded 1,000 U/L. Daily analysis of a frozen serum pool yielded a coefficient of variation of 9.2% at mean pancreatic amylase value of 54 U/L (+/- 5 U/L). A normal range study found a strong influence of age, with pancreatic amylase levels increasing dramatically in the first 3 years of life, to stabilize at a range of 0-66 U/L thereafter.

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Serum amylase isoenzyme alterations in acute abdominal conditions

Cited by 10 publications

References 9 publications

JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis

JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis

New diagnostic criteria of acute pancreatitis

Rapid measurement of serum pancreatic amylase

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