Elevated Amylase Levels as a Result of Self-Induced Hypersalivation

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 585-587
Author(s):  
Jacques Belik ◽  
Carl Tishler ◽  
Juhling McClung

A patient with recurrent vomiting, abdominal pain, and elevated serum amylase activity may have pancreatitis. Although elevated serum amylase levels are a sensitive indicator for acute pancreatitis, this test is not highly specific for pancreatic disease. A patient is described who illustrates the need for specific laboratory, historical, and occasional psychological evaluation in pediatric patients with elevated amylase values.

1978 ◽  
Vol 24 (5) ◽  
pp. 815-820 ◽  

Abstract This case focuses on the biochemical findings in acute pancreatitis and the role of the laboratory in the diagnosis and management of such patients. It also illustrates a major unappreciated problem in the use of amylase determinations in patients with acute pancreatitis: normal serum amylase activity in the presence of hyperlipemia.


2019 ◽  
Vol 12 (4) ◽  
pp. e229208
Author(s):  
Caroline Annette Erika Bachmeier ◽  
Adam Morton

Serum lipase and amylase are commonly requested in individuals presenting with abdominal pain for investigation of acute pancreatitis. Pancreatic hyperenzymaemia is not specific for acute pancreatitis, occurring in many other pancreatic and non-pancreatic conditions. Where persistent elevation of serum lipase and amylase occurs in the absence of a diagnosed cause or evidence of laboratory assay interference, ongoing radiological assessment for pancreatic disease is required for 24 months before a diagnosis of benign pancreatic hyperenzymaemia can be made. We report a case of a 71-year-old man with epigastric pain and elevated serum lipase levels. He was extensively investigated, but no pancreatic disease was detected. He is asymptomatic, but serum lipase levels remain elevated 18 months after his initial presentation.


2007 ◽  
Vol 53 (12) ◽  
pp. 2105-2111 ◽  
Author(s):  
David Schmidt ◽  
Stephen O Brennan

Abstract Background: During an investigation of genetic variants of fibrinogen, we observed a novel form of the Bβ chain, with a mass decrease of approximately 128 Da, in one of the controls. The plasma sample originated from an individual who had experienced acute pancreatitis a week earlier but whose serum amylase activity had returned to normal. We investigated the structure of the modified fibrinogen and explored its relationship to pancreatic disease. Method: Fibrinogen was isolated from the plasma of 9 individuals with increased pancreatic amylase activity (114–1826 U/L) and presumed pancreatitis and from 6 control individuals with amylase activities <56 U/L. Fibrinogen (or fibrin) Bβ chains were isolated by reversed-phase HPLC and analyzed directly by electrospray ionization mass spectrometry. Tryptic and CNBr peptide mapping and thrombin treatment pinpointed the location of the 128-Da loss in mass. Results: The acquired fibrinogen Bβ chain modification was attributable to the loss of its C-terminal glutamine residue. Incubating purified fibrinogen with pancreatic carboxypeptidase A (CpA) produced an identical modification. The des-Gln Bβ fibrinogen accounted for >80% of the Bβ chains in 3 of the individuals with increased amylase but only approximately 5% of the Bβ chains in control samples. Conclusion: Pancreatic CpA activity is used as an index of acute pancreatic disease, but given that the circulatory half-lives of fibrinogen and CpA are approximately 4 days and only 2.5 h, respectively, measuring des-Gln Bβ fibrinogen, the in vivo product of CpA activity, could provide clinicians with retrospective evidence of disease.


2017 ◽  
Vol 40 (3) ◽  
pp. 160-165
Author(s):  
Nadira Musabbir ◽  
ASM Bazlul Karim ◽  
Md Wahiduzzaman Mazumder ◽  
Kaniz Sultana ◽  
Syeda Afria Anwar ◽  
...  

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165


2019 ◽  
Author(s):  
Zsolt Balla

Introduction: Pancreatic ductal epithelial cells (PDEC) secrete an alkaline HCO_3^- rich isotonic fluid. The secretion of HCO_3^- across the apical membrane of PDEC is mediated by cystic fibrosis transmembrane conductance regulator Cl- channel (CFTR) and solute carrier family 26 (SLC26) anion exchangers. Na+/H+ exchanger regulatory factor isoform 1 (NHERF 1) is a cytosolic adaptor protein, which binds CFTR on the apical membrane of epithelial cells. Aquaporins (AQPs) facilitate the transepithelial water flow involved in epithelial fluid secretion in numerous tissues. Acute pancreatitis (AP) is a serious disorder in which specific treatment is still not possible. Accumulating evidence indicate that decreased pancreatic ductal fluid secretion plays an essential role in AP. The role of NHERF-1 in the pancreas has not yet been investigated despite the fact that CFTR, a key regulator of epithelial function, is controlled by this scaffolding protein Also the functions of AQPs in the pancreas are less characterized. Our aim was to characterize the function of NHERF-1 and AQP1 in AP. Methods: We used 12 16 week old WT, NHERF 1 knock-out (KO) and AQP1 KO male mice. In the AP groups, mice were injected 7 or 10 times hourly, intraperitoneally (i.p.) with 50 µg/kg cerulein. In another AP model, 4 % Na taurocholate was administered i.d. via the punctured duodenum. Control animals were injected i.p. or i.d. with PS instead of cerulein or Na taurocholate (n=6-8). Animals were sacrificed at 12 hours in case of the cerulein model or 24 hours in the Na taurocholate experiment. Laboratory [serum amylase or, pancreatic myeloperoxidase (MPO) activity, pancreatic IL 1β concentrations] and histological parameters (pancreatic necrosis, edema, inflammatory cell infiltration) were measured to evaluate disease severity. Expression of HSP 72, IκB α, and IκB β contents were determined by Western blot analysis. Our results showed that the induction of AP was successful in both models and also in both strains. The injection of mice with cerulein or Na taurocholate increased the measured laboratory and histological parameters vs. the control groups. The measured laboratory (serum amylase, HSP72) and histological parameters (necrosis, apoptosis) were significantly elevated in AP mice injected with cerulein vs. control mice. In accord with the measured pancreatic MPO , trypsinogen activity, IκB α, IκB β, or pancreatic IL 1β concentrations were not significantly altered in the NHERF 1 KO group vs. the WT AP groups. In case of the Na taurocholate-induced AP, pancreatic necrosis, hemorrhage and MPO activity were significantly increased in the NHERF 1 KO group vs. the WT AP group. However, the pancreatic edema, leukocyte infiltration, IL 1β concentrations and serum amylase activity were significantly elevated in the WT or NHERF 1 KO AP vs. respective control groups but not in the NHERF 1 KO vs WT AP groups. The pancreatic leukocyte infiltration, edema, necrosis or serum amylase activity were significantly increased in cerulein-treated vs. control groups. In accord with the histological results, only necrosis and serum amylase activity were increased significantly in the AQP1 KO vs. WT AP groups. In conclusion, after complete evaluation of the data, we can say that the AP in both NHERF 1 or AQP1 KO groups were more severe. These results may be due the reduced HCO_3^- and fluid secretion.


2021 ◽  
pp. 277-278
Author(s):  
Muzeyyen Uyanik ◽  
Deniz Simsek

Acute pancreatitis which is the rare reason for acute abdomen during pregnancy could cause morbidity or mortality. Physiologic changes of pregnancy affect the gall bladder and bile ingredients which play a crucial role in acute pancreatitis. Damage in the pancreas initiates local inammation and damage in the pancreas however, systemic inammatory response and multi-organ dysfunction are not rare. Additionally, acute pancreatitis during pregnancy could be a reason for preterm delivery as we aimed to present two cases in the last trimester of the pregnancy. Case 1: rd A 19-year-old woman in her 33 gestational week of pregnancy was admitted to the emergency room with acute abdominal pain and vomiting for 4 hours. She had a rm cervix on vaginal examination and ultrasonographic evaluation revealed a live fetus with a 2620 gr of estimated fetal weight, normal amniotic uid index, and placenta. Laboratory tests presented as elevated serum amylase and lipase. A hydropic gallbladder with multiple gall stones was detected in the abdominal ultrasound. The patient was hospitalized with an acute pancreatitis diagnosis. During the hospital stay, uterine th contractions had initiated and cervical dilation has progressed. The patient was delivered a live baby and discharged on the 7 hospital stay. She was performed laparoscopic cholecystectomy 4 weeks after the delivery. Case 2: th A 28-year-old woman in her 35 gestational week was admitted to the emergency department with right upper quadrant pain. Abdominal and obstetric ultrasounds were uneventful. Laboratory examination revealed an elevated serum amylase and lipase. She was hospitalized. During the hospital stay; despite the medical treatments and prevention of oral intake, the levels of amylase and lipase and the abdominal pain have progressed. The patient was delivered via cesarean section. The levels of amylase and lipase decreased progressively, and the upper quadrant abdominal pain gradually decreased. The patient was discharged on day 7. Discussion: Acute pancreatitis could cause a systemic inammatory response which could lead to preterm delivery. Upper abdominal pain is the essential symptom and elevated serum amylase and lipase about 3-fold are the most common nding. Ultrasonographic evaluation of the gall-bladder and pancreas is crucial. Magnetic resonance cholangiopancreatography without contrast medium can also be used for diagnosis. A multidisciplinary approach is essential for treatment and follow-up. Obstetricians should evaluate fetal well being, and consider acute pancreatitis as a reason for threatened preterm labor.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Joel Joy Thomas ◽  
Smrthi Mitra ◽  
Paul Vulliamy ◽  
Dixon Osilli ◽  
Samrat Mukherjee

Abstract Background Acute pancreatitis is an acute inflammatory process affecting the pancreas with variable involvement of local tissues and remote organs and may sometimes progress into necrosis of the pancreas. Diagnosis is usually made based on the clinical presentation of abdominal pain alongside a positive biochemical result of either serum amylase or lipase levels. Current guidelines by International Association of Pancreatology (IAP) state that early use of computed tomography (CT) is only indicated in patients who have no definite diagnosis, and should be delayed to at least 96 hours after the onset of the symptoms to evaluate complications. We aimed to assess the over-utilization of CT scans in the diagnosis of acute pancreatitis. Methods We performed a prospective cohort study of patients with confirmed acute pancreatitis who presented to a single NHS trust between March and April 2021. We included patients with at least two out of the three findings: (1) an acute abdominal pain, (2) elevated serum amylase levels of more than three times the normal range and (3) acute pancreatitis as evidenced on abdominal imaging. We defined inappropriate CT scans as those performed within 96 hours in the presence of both clinical and biochemical diagnostic criteria. Results A total of 53 patients met the inclusion criteria and were admitted with acute pancreatitis during this 2-month period at our trust. 54.7% (29/53) of this cohort had at least one CT scan performed during the index admission. 28.3% (15/53) of the admitted patients had an early CT scan performed in the presence of positive biochemical and clinical diagnostic criteria. This represents 51.7% of the total number of CT scans performed in the study group. Conclusions We found evidence of excessive use of CT scans in the early phase of acute pancreatitis for diagnostic purposes. Limiting the overuse of CT scans in the diagnosis of the same will not just reduce the financial burden of the hospital and trust, but also limit the avoidable exposure of patients to radiation.


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