Acute pancreatitis laboratory findings: Difference between revisions
Jump to navigation
Jump to search
| (4 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Acute pancreatitis}} | {{Acute pancreatitis}} | ||
{{CMG}}; {{AE}} {{RT}} | {{CMG}}; {{AE}} {{RT}} | ||
==Overview== | ==Overview== | ||
Laboratory tests that should be obtained include a [[complete blood count]], liver function tests, serum [[amylase]] and [[lipase]], serum [[calcium]] levels, [[arterial blood gas]], and [[blood glucose]] levels. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
* [[Complete blood count]] - [[neutrophilia]] | * [[Complete blood count]] - [[neutrophilia]] | ||
* [[kidney|Renal function]] tests | * [[kidney|Renal function]] tests impaired | ||
* Liver Function tests - LDH and AST elevated | * Liver Function tests - [[Lactate dehydrogenase|LDH]] and [[AST]] elevated | ||
* Serum calcium - reduced | * Serum calcium - reduced | ||
* Serum amylase - elevated | * Serum amylase - elevated | ||
| Line 16: | Line 16: | ||
* Blood sugar - elevated ([[hyperglycemia]]) | * Blood sugar - elevated ([[hyperglycemia]]) | ||
* Serum [[aldolase]] - elevated | * Serum [[aldolase]] - elevated | ||
* [[Carcinoembryonic antigen]]([[CEA]]) levels - | * [[Carcinoembryonic antigen]]([[CEA]]) levels - elevated | ||
* Serum [[magnesium]] - elevated | * Serum [[magnesium]] - elevated | ||
* Elevated [[fibrin degradation products]] | * Elevated [[fibrin degradation products]] | ||
===Amylase and Lipase=== | |||
=== | * Serum [[amylase]] and [[lipase]] may be used in the making of the diagnosis of acute pancreatitis. | ||
* Serum amylase and lipase may be used in the making of the diagnosis of acute pancreatitis. | * Serum [[amylase]] usually rises 2 to 12 hours from the onset of symptoms, and normalizes within 48-72 hours. | ||
* Serum amylase usually rises 2 to 12 hours from the onset of symptoms, and normalizes within 48-72 hours. | * Serum [[lipase]] rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14 days. | ||
* Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14 days. | * Serum [[amylase]] may be normal (in 10% of cases) for cases of acute on chronic pancreatitis (depleted [[acinar cell]] mass) and [[hypertriglyceridemia]]. | ||
* Serum amylase may be normal (in 10% of cases) for cases of acute on chronic pancreatitis (depleted acinar cell mass) and hypertriglyceridemia. | * Reasons for false positive elevated serum [[amylase]] include [[salivary gland]] disease (elevated salivary amylase) and [[Macroamylasemia|macro-amylasemia]]. | ||
* Reasons for false positive elevated serum amylase include salivary gland disease (elevated salivary amylase) and | * If the [[lipase]] level is about 2.5 to 3 times that of [[amylase]], it is an indication of pancreatitis due to [[alcohol]] <ref name="pmid1718808">{{cite journal |author=Gumaste V, Dave P, Weissman D, Messer J |title=Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis |journal=Gastroenterology |volume=101 |issue=5 |pages=1361-6 |year=1991 |id=PMID 1718808}}</ref>. | ||
* If the lipase level is about 2.5 to 3 times that of | |||
Regarding selection of these tests, two practice guidelines state: | Regarding selection of these tests, two practice guidelines state: | ||
: "It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some | : "It is usually not necessary to measure both serum [[amylase]] and [[lipase]]. Serum [[lipase]] may be preferable because it remains normal in some non-pancreatic conditions that increase serum amylase including [[macroamylasemia]], [[parotitis]], and some carcinomas. In general, serum [[lipase]] is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis" <ref name="pmid17032204">{{cite journal |author=Banks P, Freeman M |title=Practice guidelines in acute pancreatitis |journal=Am J Gastroenterol |volume=101 |issue=10 |pages=2379-400 |year=2006 |id=PMID 17032204 | doi=10.1111/j.1572-0241.2006.00856.x}}</ref> | ||
: "Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"<ref name="pmid15831893">{{cite journal |author=UK Working Party on Acute Pancreatitis |title=UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 | url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref> | : "Although [[amylase]] is widely available and provides acceptable accuracy of diagnosis, where [[lipase]] is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"<ref name="pmid15831893">{{cite journal |author=UK Working Party on Acute Pancreatitis |title=UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 | url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref> | ||
Most (PMID 15943725, PMID 11552931, PMID 2580467, PMID 2466075, PMID 9436862), but not all (PMID 11156345, PMID 8945483) individual studies support the superiority of the lipase. In one large study, there were no patients with pancreatitis who had an elevated amylase with a normal lipase <ref name="pmid15943725">{{cite journal |author=Smith R, Southwell-Keely J, Chesher D |title=Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis? |journal=ANZ J Surg |volume=75 |issue=6 |pages=399-404 |year=2005 |id=PMID 15943725 | doi=10.1111/j.1445-2197.2005.03391.x}}</ref>. Another study found that the amylase could add diagnostic value to the lipase, but only if the results of the two tests were combined with a discriminant function equation <ref name="pmid7504593">{{cite journal |author=Corsetti J, Cox C, Schulz T, Arvan D |title=Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis |journal=Clin Chem |volume=39 |issue=12 |pages=2495-9 |year=1993 |id=PMID 7504593}}</ref>. | Most (PMID 15943725, PMID 11552931, PMID 2580467, PMID 2466075, PMID 9436862), but not all (PMID 11156345, PMID 8945483) individual studies support the superiority of the [[lipase]]. In one large study, there were no patients with pancreatitis who had an elevated [[amylase]] with a normal [[lipase]] <ref name="pmid15943725">{{cite journal |author=Smith R, Southwell-Keely J, Chesher D |title=Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis? |journal=ANZ J Surg |volume=75 |issue=6 |pages=399-404 |year=2005 |id=PMID 15943725 | doi=10.1111/j.1445-2197.2005.03391.x}}</ref>. Another study found that the [[amylase]] could add diagnostic value to the [[lipase]], but only if the results of the two tests were combined with a discriminant function equation <ref name="pmid7504593">{{cite journal |author=Corsetti J, Cox C, Schulz T, Arvan D |title=Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis |journal=Clin Chem |volume=39 |issue=12 |pages=2495-9 |year=1993 |id=PMID 7504593}}</ref>. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
[[Category:Emergency medicine]] | |||
{{WS}} | |||
{{WH}} | {{WH}} | ||
Latest revision as of 20:25, 2 December 2017
|
Acute pancreatitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Acute pancreatitis laboratory findings On the Web |
|
American Roentgen Ray Society Images of Acute pancreatitis laboratory findings |
|
Risk calculators and risk factors for Acute pancreatitis laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Laboratory tests that should be obtained include a complete blood count, liver function tests, serum amylase and lipase, serum calcium levels, arterial blood gas, and blood glucose levels.
Laboratory Findings
- Complete blood count - neutrophilia
- Renal function tests impaired
- Liver Function tests - LDH and AST elevated
- Serum calcium - reduced
- Serum amylase - elevated
- Serum lipase - elevated
- Arterial blood gas
- Blood sugar - elevated (hyperglycemia)
- Serum aldolase - elevated
- Carcinoembryonic antigen(CEA) levels - elevated
- Serum magnesium - elevated
- Elevated fibrin degradation products
Amylase and Lipase
- Serum amylase and lipase may be used in the making of the diagnosis of acute pancreatitis.
- Serum amylase usually rises 2 to 12 hours from the onset of symptoms, and normalizes within 48-72 hours.
- Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14 days.
- Serum amylase may be normal (in 10% of cases) for cases of acute on chronic pancreatitis (depleted acinar cell mass) and hypertriglyceridemia.
- Reasons for false positive elevated serum amylase include salivary gland disease (elevated salivary amylase) and macro-amylasemia.
- If the lipase level is about 2.5 to 3 times that of amylase, it is an indication of pancreatitis due to alcohol [1].
Regarding selection of these tests, two practice guidelines state:
- "It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some non-pancreatic conditions that increase serum amylase including macroamylasemia, parotitis, and some carcinomas. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis" [2]
- "Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"[3]
Most (PMID 15943725, PMID 11552931, PMID 2580467, PMID 2466075, PMID 9436862), but not all (PMID 11156345, PMID 8945483) individual studies support the superiority of the lipase. In one large study, there were no patients with pancreatitis who had an elevated amylase with a normal lipase [4]. Another study found that the amylase could add diagnostic value to the lipase, but only if the results of the two tests were combined with a discriminant function equation [5].
References
- ↑ Gumaste V, Dave P, Weissman D, Messer J (1991). "Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis". Gastroenterology. 101 (5): 1361–6. PMID 1718808.
- ↑ Banks P, Freeman M (2006). "Practice guidelines in acute pancreatitis". Am J Gastroenterol. 101 (10): 2379–400. doi:10.1111/j.1572-0241.2006.00856.x. PMID 17032204.
- ↑ UK Working Party on Acute Pancreatitis (2005). "UK guidelines for the management of acute pancreatitis". Gut. 54 Suppl 3: iii1–9. doi:10.1136/gut.2004.057026. PMID 15831893.
- ↑ Smith R, Southwell-Keely J, Chesher D (2005). "Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis?". ANZ J Surg. 75 (6): 399–404. doi:10.1111/j.1445-2197.2005.03391.x. PMID 15943725.
- ↑ Corsetti J, Cox C, Schulz T, Arvan D (1993). "Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis". Clin Chem. 39 (12): 2495–9. PMID 7504593.