scholarly journals A case of acute pancreatitis with normal serum amylase and lipase value

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Jayanta Paul ◽  
Keyword(s):  
Acute Pancreatitis ◽  
Ct Scan ◽  
Acute Pain ◽  
Serum Amylase ◽  
Elevated Serum ◽  
Serum Triglyceride ◽  
Normal Serum ◽  
Upper Limit ◽  
Pain Abdomen ◽  
Rule Out

There are several causes of acute pancreatitis (AP). In clinical practice, AP is diagnosed by presence of acute pain abdomen, elevated serum amylase and lipase value (>3 times of upper limit of normal) and ultrasonographic (USG) findings of acute pancreatitis but in only 25-50% of patients with acute pancreatitis, pancreas is visualised. In this case, 44 years gentleman was presented with acute pain abdomen, normal serum amylase and lipase value and no pancreatic abnormality in abdominal USG. After diagnosis of elevated serum triglyceride, computed tomography (CT scan) of abdomen was done to exclude hypertriglyceridemia induced AP. CT scan abdomen showed features of acute pancreatitis. Therefore, in every patient with acute pain abdomen if serum amylase and lipase value and USG abdomen are normal, serum triglyceride should be advised to rule out hypertriglyceridemia induced AP. In this case report we are going to present a case of acute pancreatitis with normal serum amylase and lipase value.

scholarly journals P-P52 Overuse of CT scans in the diagnosis of Acute Pancreatitis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Joel Joy Thomas ◽  
Smrthi Mitra ◽  
Paul Vulliamy ◽  
Dixon Osilli ◽  
Samrat Mukherjee
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Diagnostic Criteria ◽  
Serum Amylase ◽  
International Association ◽  
Financial Burden ◽  
Elevated Serum ◽  
Ct Scans ◽  
Current Guidelines

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.

Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: Cohort analysis of 1457 patients

Pancreatology ◽  
2019 ◽  
Vol 19 (5) ◽  
pp. 623-629 ◽  
Author(s):  
Isabel Pascual ◽  
Ana Sanahuja ◽  
Natalia García ◽  
Paola Vázquez ◽  
Oswaldo Moreno ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cohort Analysis ◽  
Elevated Serum ◽  
Serum Triglyceride

Acute pancreatitis

2010 ◽  
pp. 2557-2567
Author(s):  
R. Carter ◽  
C.J. McKay
Keyword(s):  
Acute Pancreatitis ◽  
Peptic Ulcer ◽  
Gastric Ulcer ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Perforated Peptic Ulcer ◽  
Upper Limit ◽  
Abdominal Emergencies ◽  
Idiopathic Acute Pancreatitis ◽  
Upper Abdominal

Acute pancreatitis affects 300 to 600 new patients per million population per year and is most commonly caused by gallstones or alcohol, but there are many other causes and associations. Careful imaging reveals that most so-called idiopathic acute pancreatitis is due to small (1–3 mm diameter) gallstones. Diagnosis is made by a combination of a typical presentation (upper abdominal pain and vomiting) in conjunction with raised serum amylase (> × 3 upper limit of normal) and/or lipase (> × 2 upper limit of normal). Several acute abdominal emergencies can mimic acute pancreatitis and may be associated with a raised serum amylase. These include perforated peptic ulcer (particularly perforated posterior gastric ulcer) and acute mesenteric ischaemia. In equivocal cases, a CT scan is indicated in order to exclude other causes and confirm the diagnosis....

(Washington University case conference): acute pancreatitis, hyperlipemia, and normal amylase.

1978 ◽  
Vol 24 (5) ◽  
pp. 815-820 ◽  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Amylase Activity ◽  
Normal Serum ◽  
Case Conference ◽  
Diagnosis And Management ◽  
Serum Amylase Activity ◽  
Washington University

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.

scholarly journals Acute Pancreatitis with Rapid Clinical Improvement in a Child with Isovaleric Acidemia

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Elpis Mantadakis ◽  
Ioannis Chrysafis ◽  
Emmanouela Tsouvala ◽  
Athanassios Evangeliou ◽  
Athanassios Chatzimichael
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Acute Abdominal Pain ◽  
Elevated Serum ◽  
Unknown Origin ◽  
Organic Acidemia ◽  
Abdominal Ultrasonography ◽  
Isovaleric Acidemia ◽  
Intravenous Hydration ◽  
Branched Chain

Isovaleric acidemia is a rare branched-chain organic acidemia. The authors describe a 3.5-year-old girl with isovaleric acidemia and acute abdominal pain associated with bilious emesis. Elevated serum amylase and abdominal ultrasonography demonstrating an enlarged and edematous pancreas, along with the presence of peripancreatic exudates, confirmed the presence of acute pancreatitis. The patient recovered quickly with intravenous hydration, pancreatic rest, and administration of intravenous L-carnitine. Pancreatitis should be ruled out in the context of vomiting in any patient with isovaleric acidemia. Conversely, branched-chain organic acidemias should be included in the differential diagnosis of any child with pancreatitis of unknown origin.

scholarly journals Abdominal pain and a raised amylase? It’s not always pancreatitis…

2013 ◽  
Vol 12 (3) ◽  
pp. 163-165
Author(s):  
IO Oluwatowoju ◽  
◽  
EO Abu ◽  
G Lawson ◽  
◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Epigastric Pain ◽  
Elevated Serum ◽  
High Serum ◽  
Amylase Level ◽  
Serum Amylase Level ◽  
Heavy Alcohol ◽  
Heavy Alcohol Consumption ◽  
History Of

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

scholarly journals Serum Hydroxybutyrate dehydrogenase as an early predictive marker of the severity of acute pancreatitis: a retrospective study

2020 ◽  
Author(s):  
weiming xiao ◽  
Weili Liu ◽  
Ling Yin ◽  
Yong Li ◽  
Guotao Lu ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Retrospective Study ◽  
Organ Failure ◽  
Early Stage ◽  
Laboratory Data ◽  
Elevated Serum ◽  
High Serum ◽  
Normal Serum ◽  
Receiver Operating Curve ◽  
Persistent Organ Failure

Abstract Background: To investigate the value of serum hydroxybutyrate dehydrogenase (HBDH) level, an isozyme of lactate dehydrogenase (LDH), in evaluating the severity of acute pancreatitis (AP).Methods: Patients diagnosed with AP from January 2013 to December 2018 were included in this retrospective study. Patients were divided into the normal serum HBDH levels group (n-HBDH group) and the high serum HBDH levels group (h-HBDH group) according to the criteria HBDH ≥ 182 U/L after admission. The demographic parameters, laboratory data and the severity of AP in the two groups were compared. The receiver operating curve (ROC) was used to evaluate the efficacy of serum HBDH in predicting persistent organ failure and systemic inflammatory response syndrome (SIRS).Results: A total of 260 AP patients were enrolled, including 176 cases in the n-HBDH group and 84 cases in the h-HBDH group. The incidence of SIRS and organ failure in the h-HBDH group were significantly higher than those in n-HBDH group (both P < 0.001). In addition, the HBDH level was significantly decreased in 110 patients who were re-measured after AP treatment. The serum HBDH levels were positively correlated with Atlanta classification, Ranson score, and BISAP score (all P < 0.05). ROC analysis showed that a serum HBDH cut-off point of 195.0 U/L had optimal predictive value for the development of persistent organ failure (AUC = 0.778) and 166.5 U/L for the development of SIRS (AUC = 0.724).Conclusion: The elevated serum HBDH in early stage of AP is closely related to the adverse prognosis of AP patients, which can be used as a potential early biomarker for predicting the severity of AP.

Misdiagnosis of macroamylasemia in pregnancy as pancreatitis

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Ayla Eser ◽  
Nilufer Akgun ◽  
Ebru Yuce ◽  
Hasan Kafali
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Present Report ◽  
Elevated Serum ◽  
Normal Serum ◽  
Invasive Treatment ◽  
Serum Lipase ◽  
Urinary Amylase ◽  
In Pregnancy

AbstractWhile elevated serum amylase in the presence of abdominal pain can be indicative of pancreatitis, differential diagnosis of macroamylasemia depends on additional assessment of serum lipase and urinary amylase. The present report concerns misdiagnosis of pancreatitis in a pregnant woman with elevated serum amylase but normal lipase.The patient was a nulligravid woman on her first pregnancy diagnosed with pancreatitis in her 32Normal serum lipase levels should be considered as a likely indication of an alternative cause of elevated serum amylase to pancreatitis, and urinary amylase should be routinely checked to assist in differential diagnosis to avoid unnecessary and invasive treatment and stress to pregnant women.

scholarly journals Serum hydroxybutyrate dehydrogenase as an early predictive marker of the severity of acute pancreatitis: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Weiming Xiao ◽  
Weili Liu ◽  
Ling Yin ◽  
Yong Li ◽  
Guotao Lu ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Retrospective Study ◽  
Organ Failure ◽  
Early Stage ◽  
Laboratory Data ◽  
Elevated Serum ◽  
High Serum ◽  
Normal Serum ◽  
Receiver Operating Curve ◽  
Persistent Organ Failure

Abstract Background To investigate the value of serum hydroxybutyrate dehydrogenase (HBDH) level, an isozyme of lactate dehydrogenase, in evaluating the severity of acute pancreatitis (AP). Methods Patients diagnosed with AP from January 2013 to December 2018 were included in this retrospective study. Patients were divided into the normal serum HBDH levels group (n-HBDH group) and the high serum HBDH levels group (h-HBDH group) according to the criteria HBDH ≥ 182 U/L after admission. The demographic parameters, laboratory data and the severity of AP in the two groups were compared. The receiver operating curve (ROC) was used to evaluate the efficacy of serum HBDH in predicting persistent organ failure and systemic inflammatory response syndrome (SIRS). Results A total of 260 AP patients were enrolled, including 176 cases in the n-HBDH group and 84 cases in the h-HBDH group. The incidence of SIRS and organ failure in the h-HBDH group were significantly higher than those in n-HBDH group (both P < 0.001). In addition, the HBDH level was significantly decreased in 110 patients who were re-measured after AP treatment. The serum HBDH levels were positively correlated with Atlanta classification, Ranson score, and BISAP score (all P < 0.05). ROC analysis showed that a serum HBDH cut-off point of 195.0 U/L had optimal predictive value for the development of persistent organ failure (AUC = 0.778) and 166.5 U/L for the development of SIRS (AUC = 0.724). Conclusion The elevated serum HBDH in early stage of AP is closely related to the adverse prognosis of AP patients, which can be used as a potential early biomarker for predicting the severity of AP.

Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country

2020 ◽  
Vol 13 (8) ◽  
pp. e234988
Author(s):  
Ami Schattner ◽  
Ina Dubin ◽  
Yair Glick ◽  
Elizabeth Nissim
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Liver Enzymes ◽  
Elevated Serum ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Diagnostic Challenge ◽  
Reactive Protein ◽  
Animal Contact ◽  
Low Incidence

A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians’ low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.

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