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PERITONEAL FLUID AMYLASE DETERMINATIONS AS AN AID IN DIAGNOSIS OF ACUTE PANCREATITIS

PERITONEAL FLUID AMYLASE DETERMINATIONS AS AN AID IN DIAGNOSIS OF ACUTE PANCREATITIS Abstract THE DIAGNOSIS of acute pancreatitis is a common challenge even to the most alert clinician. Although an increased blood amylase level is a well recognized diagnostic criterion in acute pancreatitis,1 this value frequently falls below diagnostic levels within 48 to 72 hours after the onset of the disease.2 Furthermore, other tests designed for the diagnosis of late acute pancreatitis are less specific3 and too time consuming. Patients seen relatively late in the course of acute pancreatitis who present residual signs and symptoms and a normal blood amylase often present difficult diagnostic problems. Previous observations4 have demonstrated that the peritoneal fluid obtained from these patients at the time of laparotomy has a high amylase value. This finding suggested that a diagnosis in late cases of pancreatitis might be established by an analysis of fluid obtained by paracentesis. The study of the amylase value of fluid obtained by References 1. Elman, R.: The Variations of Blood Amylase During Acute Transient Disease of the Pancreas , Ann. Surg. 105:379 ( (March) ) 1937.Crossref 2. McCaughan, J. M.: The Value of Estimations of the Amylase of the Blood in the Diagnosis of Suspected Pancreatic Disease , Surg., Gynec. & Obst. 59:598 ( (Oct.) ) 1934. 3. McCorkle, H.; Goldman, L., and Cornell, R. N.: Significance of the Determination of Serum Amylase in the Diagnosis and Management of Acute Pancreatitis , Clinics 1:756 ( (Oct.) ) 1942. 4. (a) Cole, W. H.: The Pancreas , in Spivack, J. L.: Urgent Surgery , Springfield, Ill., Charles C Thomas, Publisher, 1946, vol. 1, p. 246. 5. (b) Paxton, J. R., and Payne, J. H.: Acute Pancreatitis: Statistical Review of 307 Established Cases of Acute Pancreatitis , Surg., Gynec. & Obst. 86:69 ( (Jan.) ) 1948. 6. (c) Warren, K. W.: Acute Pancreatitis , S. Clin. North America 28:741 ( (June) ) 1948. 7. (d) Howard, J. M.: Surgical Physiology of the Pancreas , S. Clin. North America 29:1789 ( (Dec.) ) 1949. 8. Nemir, P.; Hawthorne, H. R., and Lecrone, B. L.: Increase of Serum Lipase in Experimentally Produced Appendical Peritonitis , Arch. Surg. 59:337 ( (Aug.) ) 1949. 9. McCleery, R. S., and Keith, L. M.: Unpublished data. Howard.2d 10. (a) Rothman, M.: Disturbances of the Pancreas and the Use of the Amylase Test , Am. J. Surg. 78:256 ( (Aug.) ) 1949. 11. Pinkham, in discussion on Collins, J. D.: [ Case of Acute Pancreatitis ], Northwest Med. 47:123 ( (Feb.) ) 1948. 12. Pemberton, A. H.; Grindlay, J. H., and Bollman, J. L.: Serum Amylase Levels After Acute Perforations of the Duodenum: A Preliminary Report , Proc. Staff Meet., Mayo Clin. 25:5 ( (Jan. 4) ) 1950. 13. Crowley, R. T., and Winfield, J. M.: Collective Review: Intestinal Strangulating Obstructions of the Bowel . Surg., Gynec. & Obst. 89:417 ( (Nov.) ) 1949. 14. Somogyi, M.: Micromethods for the Estimation of Diastase , J. Biol. Chem. 125:399, 1938. 15. Rhoads, J. E.; Howard, J. M., and Moss, N. H.: Clinical Experiences with Surgical Lesions of the Pancreas , S. Clin. North America 29:1801 ( (Dec.) ) 1949. 16. Probstein, J. G.; Gray, S. H.; Sachar, L. A., and Rindskopf, W. J.: Surgical Implications of Acute Pancreatitis: An Analysis of 85 Cases , Arch. Surg. 59:189 ( (Aug.) ) 1949. 17. Lampson, R. S.: Acute Pancreatitis: Report of 29 Cases , Ann. Surg. 115:367 ( (Sept.) ) 1942. 18. Keith, L. M., and Zollinger, R. M.: To be published. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

PERITONEAL FLUID AMYLASE DETERMINATIONS AS AN AID IN DIAGNOSIS OF ACUTE PANCREATITIS

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1950 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1950.01250020938014
Publisher site
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Abstract

Abstract THE DIAGNOSIS of acute pancreatitis is a common challenge even to the most alert clinician. Although an increased blood amylase level is a well recognized diagnostic criterion in acute pancreatitis,1 this value frequently falls below diagnostic levels within 48 to 72 hours after the onset of the disease.2 Furthermore, other tests designed for the diagnosis of late acute pancreatitis are less specific3 and too time consuming. Patients seen relatively late in the course of acute pancreatitis who present residual signs and symptoms and a normal blood amylase often present difficult diagnostic problems. Previous observations4 have demonstrated that the peritoneal fluid obtained from these patients at the time of laparotomy has a high amylase value. This finding suggested that a diagnosis in late cases of pancreatitis might be established by an analysis of fluid obtained by paracentesis. The study of the amylase value of fluid obtained by References 1. Elman, R.: The Variations of Blood Amylase During Acute Transient Disease of the Pancreas , Ann. Surg. 105:379 ( (March) ) 1937.Crossref 2. McCaughan, J. M.: The Value of Estimations of the Amylase of the Blood in the Diagnosis of Suspected Pancreatic Disease , Surg., Gynec. & Obst. 59:598 ( (Oct.) ) 1934. 3. McCorkle, H.; Goldman, L., and Cornell, R. N.: Significance of the Determination of Serum Amylase in the Diagnosis and Management of Acute Pancreatitis , Clinics 1:756 ( (Oct.) ) 1942. 4. (a) Cole, W. H.: The Pancreas , in Spivack, J. L.: Urgent Surgery , Springfield, Ill., Charles C Thomas, Publisher, 1946, vol. 1, p. 246. 5. (b) Paxton, J. R., and Payne, J. H.: Acute Pancreatitis: Statistical Review of 307 Established Cases of Acute Pancreatitis , Surg., Gynec. & Obst. 86:69 ( (Jan.) ) 1948. 6. (c) Warren, K. W.: Acute Pancreatitis , S. Clin. North America 28:741 ( (June) ) 1948. 7. (d) Howard, J. M.: Surgical Physiology of the Pancreas , S. Clin. North America 29:1789 ( (Dec.) ) 1949. 8. Nemir, P.; Hawthorne, H. R., and Lecrone, B. L.: Increase of Serum Lipase in Experimentally Produced Appendical Peritonitis , Arch. Surg. 59:337 ( (Aug.) ) 1949. 9. McCleery, R. S., and Keith, L. M.: Unpublished data. Howard.2d 10. (a) Rothman, M.: Disturbances of the Pancreas and the Use of the Amylase Test , Am. J. Surg. 78:256 ( (Aug.) ) 1949. 11. Pinkham, in discussion on Collins, J. D.: [ Case of Acute Pancreatitis ], Northwest Med. 47:123 ( (Feb.) ) 1948. 12. Pemberton, A. H.; Grindlay, J. H., and Bollman, J. L.: Serum Amylase Levels After Acute Perforations of the Duodenum: A Preliminary Report , Proc. Staff Meet., Mayo Clin. 25:5 ( (Jan. 4) ) 1950. 13. Crowley, R. T., and Winfield, J. M.: Collective Review: Intestinal Strangulating Obstructions of the Bowel . Surg., Gynec. & Obst. 89:417 ( (Nov.) ) 1949. 14. Somogyi, M.: Micromethods for the Estimation of Diastase , J. Biol. Chem. 125:399, 1938. 15. Rhoads, J. E.; Howard, J. M., and Moss, N. H.: Clinical Experiences with Surgical Lesions of the Pancreas , S. Clin. North America 29:1801 ( (Dec.) ) 1949. 16. Probstein, J. G.; Gray, S. H.; Sachar, L. A., and Rindskopf, W. J.: Surgical Implications of Acute Pancreatitis: An Analysis of 85 Cases , Arch. Surg. 59:189 ( (Aug.) ) 1949. 17. Lampson, R. S.: Acute Pancreatitis: Report of 29 Cases , Ann. Surg. 115:367 ( (Sept.) ) 1942. 18. Keith, L. M., and Zollinger, R. M.: To be published.

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A.M.A. Archives Surgery – American Medical Association

Published: Nov 1, 1950

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