Most studies show that levels of greater than three times the upper limit of normal usually lead to a diagnosis of pancreatitis, according to guidelines from the American College of Gastroenterology ACG. When these test results are abnormal, you may need other tests such as an ultrasound, CT scan, MRI scan, and endoscopy.
However, lipase levels compared with amylase levels are usually more specific for pancreatic disorders. Evaluating the results of the two tests and your symptoms can help your doctor diagnose or rule out pancreatitis or other conditions of the pancreas.
If you experience severe abdominal pain, see your doctor immediately. Based on the results of an amylase test, a lipase test, and your medical history, your doctor can decide if additional tests are needed or determine what type of treatment is needed. Pancreatitis is inflammation of the pancreas and causes abdominal tenderness and pain.
Learn more. Amylase levels that are too high or low may indicate an issue with your pancreas. See why an amylase blood test is done and what the results mean for…. The enzyme lipase is made by the pancreas and released into the digestive tract when you eat. Certain lipase levels are needed to maintain normal…. Acute pancreatitis is an inflammation in the pancreas, which causes pain and swelling in the upper left side of the abdomen, nausea, and burping. In cases of chronic pancreatitis, your diet might have a lot to do with what's causing the problem.
Researchers have identified certain foods you can…. Understand pancreas divisum, including what to eat and how to prevent pancreatitis. Surgery to remove the whole pancreas is rarely done anymore. However, you might need this surgery if you have pancreatic cancer, severe pancreatitis…. Health Conditions Discover Plan Connect. Amylase and Lipase Tests.
Medically reviewed by Judith Marcin, M. When the pancreas is inflamed, increased blood levels of the pancreatic enzymes called amylase and lipase will result. Normal values may vary from laboratory to laboratory. If you experience high blood lipase levels hyperlipasemia , and are without symptoms, you doctor or healthcare provider may tell you to avoid alcohol and narcotics, and closely monitor your laboratory values and symptoms. Medications used to aid in digestion include:.
Several recent evidence-based guidelines recommend the use of lipase over amylase. Nevertheless, both lipase and amylase alone lack the ability to determine the severity and etiology of acute pancreatitis. The co-ordering of both tests has shown little to no increase in the diagnostic sensitivity and specificity. Thus, unnecessary testing and laboratory expenditures can be reduced by testing lipase alone. Based on median sensitivities and specificities, an elevated trypsin level has a better likelihood ratio for detecting pancreatitis than the amylase level and is probably the most accurate serum indicator for acute pancreatitis.
However, a serum trypsin assay is not widely available and therefore is not routinely used. Hepatic Function Studies. Hepatic transaminase levels may be elevated in patients with pancreatitis caused by alcohol abuse or cholelithiasis with obstruction. However, these tests are not sufficiently reliable for diagnosing acute biliary pancreatitis or determining its etiology. Plain Radiographs. Plain radiographs may support the diagnosis of acute pancreatitis when certain findings are present Table 3.
Ultrasonography is an acceptable study for initial evaluation when biliary causes are suspected. Pancreatic ultrasonography has these advantages: it is noninvasive, relatively inexpensive and may be performed at the bedside. The sensitivity of this study in detecting pancreatitis is 62 to 95 percent. Computed Tomography CT.
The contrast-enhanced CT scan provides the best imaging of the pancreas and surrounding structures. A CT study may be useful when other diagnostic studies are inconclusive, when the patient has severe symptoms, when fever is present or in the face of persistent leukocytosis that suggests secondary infection. The CT findings in pancreatitis may show inflammation characterized by diffuse or segmental enlargement of the pancreas, with irregular contour and obliteration of peripancreatic fat, necrosis or a pseudocyst 15 Figures 2 through 4.
Contrast-enhanced axial computed tomographic section of the upper abdomen showing peripancreatic and retroperitoneal edema large arrows and stranding. The pancreas itself small arrow appears relatively normal. Contrast-enhanced axial computed tomographic section of the upper abdomen showing peripancreatic and retroperitoneal edema.
Large non-enhancing areas of necrosis are visible in the body and neck of the pancreas arrows. Contrast-enhanced axial computed tomographic section of the upper abdomen showing a well-defined fluid collection in the retroperitoneum arrow just below the level of the pancreas. ERCP has a limited role in management of acute pancreatitis.
It is primarily indicated in patients with severe disease who are suspected of having biliary obstruction. The risks of performing ERCP with sphincterotomy include precipitating an acute episode of pancreatitis, introducing infection and causing hemorrhage and perforation. At least one study has shown that patients with severe biliary pancreatitis show a reduction in morbidity and mortality with early less than 24 hours ERCP.
About 20 to 30 percent of patients with acute pancreatitis develop complications of necrosis, organ failure, or both 18 — 20 Table 4.
Natural course of acute pancreatitis. World J Surg ;—5. Clinical monitoring is inadequate for determining severity and predicting the course of pancreatitis because it only detects about 39 percent of severe cases.
Several systems have been developed in an attempt to provide reliable prognostic classification for patients with acute pancreatitis. In addition, they can be repeated daily to monitor disease progression.
A score of 30 to 34 was associated with 73 percent mortality, while patients with scores above 35 had an 84 percent mortality. Arterial pH. For patients with history of severe organ system insufficiency or immunocompromise, assign points as follows:.
Nonoperative or emergency postoperative: 5 points Elective postoperative: 2 points. Cardiac arrest. Acute myocardial infarction. Disseminated intravascular coagulation. Stress ulcer necessitating transfusion of more than 2 units of blood per 24 hours. Acalculus cholecystitis. Necrotizing enterocolitis. Bowel perforation. Score varies from zero to 7. Evaluation of severity in patients with acute pancreatitis. Am J Gastroenterol ;—8. In addition, the MOSF system has better clinical utility for evaluating patients at admission and at 48 hours.
Most complications of acute pancreatitis and subsequent deaths occur within two weeks of onset of pain. Secondary pancreatic infection is the most common cause of death in acute pancreatitis, accounting for 70 to 80 percent of deaths.
Pulmonary insufficiency may range from mild atelectasis to life-threatening adult respiratory distress syndrome. Acute renal failure defined as a twofold creatinine rise may ensue secondary to cardiovascular collapse and hypotension, resulting in acute tubular necrosis.
CT scanning may detect late complications of pancreatitis. Complications that usually occur after three weeks include pseudocysts and abscess formation. Pseudocysts occur in about 1 to 8 percent of cases. Abscesses occur in 1 to 4 percent of patients. The treatment of pancreatitis may be conservative or complex, depending on the severity of the presentation and the development of complications. A patient with a history and physical examination consistent with pancreatitis should have laboratory studies, including determination of amylase, lipase and, if available, serum trypsin levels to confirm the diagnosis.
Additional tests that are helpful are a complete blood cell count and hepatic function tests. Most authorities recommend that radiographs of the chest and abdomen be obtained on presentation to rule out bowel perforation or early pulmonary complications. Ultrasonography is indicated only if the clinical presentation or laboratory assessment suggests biliary disease.
Baseline CT scanning is indicated in the following situations: 1 the diagnosis is in doubt; 2 severe pancreatitis is suspected because of high fever higher than In addressing the patient's pain, analgesia with meperidine Demerol along with an antiemetic is preferred over the use of morphine, because morphine may cause spasm of the sphincter of Oddi, which has the potential to worsen the condition.
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