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The Laboratory Diagnosis of Pancreatic Disease

The Laboratory Diagnosis of Pancreatic Disease Abstract The diagnosis of pancreatic disease is gradually improving, largely as a result of increasing experience in correlating laboratory data reflecting normal and altered physiologic function and newer techniques for assessing the digestive capacity of pancreatic enzymes. Characteristic alterations of the quantity and constituents of the duodenal content have been established. These refinements have emphasized the importance of adequate understanding of the type, mechanism, and application of pancreatic function tests. In the present discussion these procedures are classified with respect to the moiety analyzed or the specific function evaluated (Table 1). Determinations of Blood or Serum Constituents A. Serum Amylase. —Since Elman and his associates,9 in 1929, confirmed the presence of an increased serum amylase activity in inflammation or obstruction of the pancreatic duct, this analysis has become the most widely applied test of pancreatic disease. Although several biochemical systems have been employed, the saccharogenic method of Somogyi10,11 is References 1. Dreiling, D. A.: An Evaluation of Pancreatic Function Tests , New York J. Med. 53:671-675, 1953. 2. Dreiling, D. A., and Richman, A.: Pancreatitis: A Review , J. Mt. Sinai Hosp. New York 21:122-136, 1954. 3. Machella, T. E.: Useful Diagnostic Laboratory Procedures in Pancreatitis , A. M. A. Arch. Int. Med. 96:322-331, 1955.Crossref 4. Dreiling, D. A., and Janowitz, H. D.: The Pathophysiology of the Pancreas , Advances Int. Med. 7:65-99, 1955. 5. Dreiling, D. A., and Janowitz, H. D.: Exocrine Pancreatic Secretion: Effects of Pancreatic Disease , Am. J. Med. 21:98-116, 1956.Crossref 6. Thomas, J. E.: Physiology of the Digestive Tract , M. Clin. North America 40:273-290, 1956. 7. Dreiling, D. A., and Janowitz, H. D.: A Review of Modern Concepts of Pancreatic Disease: Part I—The Etiology and Pathogenesis of Pancreatic Inflammation , New York J. Med. 56:2992-3003, 1956 8. Part II—The Physiologic Basis of Therapy in Pancreatitis , New York J. Med. 56: 3141-3147, 1956. 9. Pollard, H. M., and Bolt, R. J.: Some Newer Tests Used in Diagnosis of Diseases of the Stomach and Pancreas , M. Clin. North America 40:403-416, 1956. 10. Elman, R.; Arneson, N., and Graham, E. A.: Value of Blood Amylase Estimations in the Diagnosis of Pancreatic Disease: A Clinical Study , Arch. Surg. 19:943-967, 1929.Crossref 11. Somogyi, M.: Micromethods for Estimation of Diastase , J. Biol. Chem. 125:399-414, 1938. 12. Somogyi, M.: Blood Diastase in Health and Disease , J. Biol. Chem. 134:315-318, 1940. 13. Shaldon, S.: Estimation of Serum-Amylase: A Simplified Method , Lancet 2:547, 1956.Crossref 14. Street, H. V., and Close, J. R.: Determination of Amylase Activity in Biological Fluids , Clin. chim. acta 1:256-268, 1956.Crossref 15. Popper, H. L., and Necheles, H.: Pathways of Enzymes into the Blood in Acute Damage of the Pancreas , Proc. Soc. Exper. Biol. & Med. 43:220-222, 1940. 16. Carruthers, A.: The Hydrolysis of Glycogen by Muscle and Liver Extracts , J. Biol. Chem. 108:535-545, 1935. 17. Mirsky, A.: Metabolism of Adipose Tissue in Vitro , Biochem. J. 36:232-241, 1942. 18. Brunschwig, A.; Ricketts, H. T., and Bigelow, R. R.: Total Pancreatectomy, Total Gastrectomy, Total Duodenectomy, Splenectomy, Left Adrenalectomy and Omentectomy in a Diabetic Patient, Recovery , Surg. Gynec. & Obst. 80:252-256. 1945. 19. Starkloff, G. B.; Knight, W. A., Jr., and Pollack, R.: The Management of Chronic Pancreatitis: A Critical Evaluation , Am. Surgeon 20:435-444, 1954. 20. Dankner, A., and Heifetz, C. J.: The Interrelationship of Blood and Urine Diastase During Transient Acute Pancreatitis , Gastroenterology 18:207-217, 1951. 21. Meroney, W. H.; Lawson, N. L.; Rubini, M. E., and Carbone, J. V.: Some Observations of the Behavior of Amylase in Relation to Acute Renal Insufficiency , New England J. Med. 255: 315-320, 1956.Crossref 22. Janowitz, H. D., and Hollander, F.: The Exocrine-Endocrine Partition of Enzymes in the Digestive Tract, Comments , Gastroenterology 17: 591-593, 1951. 23. Howard, J. M.; Smith, A. K., and Peters, J. J.: Acute Pancreatitis: Pathways of Enzymes into the Blood Stream , Surgery 26:161-166, 1949. 24. Ross, C. A., and Klinge, F. W.: Pain and Hyperamylasemia as Early Signs of Carcinoma of the Head of the Pancreas and of the Ampulla of Vater , Gastroenterology 12:204-208, 1949. 25. Gambill, E. E.; Waugh, J. M., and Dockerty, M. B.: Persistent Elevation of Serum Amylase and Lipase Due to Carcinoma of the Pancreas Masquerading as Chronic Pancreatitis: Report of Case , Gastroenterology 17:290-293, 1951. 26. Malinowski, T. S.: Clinical Value of Serum Amylase Determination , J. A. M. A. 149:1380-1385, 1952.Crossref 27. Popper, H. L., and Plotke, F.: Studies on Pancreatitis: Observations on the Disappearance of Experimentally Increased Blood Amylase and Lipase , Surgery 9:706-711, 1941. 28. Howard, J. M.; Frawley, J. P., and Artz, C. P.: A Study of Plasma Amylase Activity in the Combat Casualty: The Systemic Response to Injury , Ann. Surg. 141:337-341, 1955.Crossref 29. Muether, R. O., and Knight, W. A., Jr.: Chronic Recurrent Pancreatitis: I. Clinical and Laboratory Aspects , Gastroenterology 12:24-33, 1949. 30. Sullivan, J. F.; Healey, R. J., and Knight, W. A., Jr.: Alterations in Serum Diastase and Albumin Values in Protein Deficiency , Gastroenterology 28:550-562, 1955. 31. Saint, E. G., and Topliss, J.: Pancreatitis , Med. Illus. 9:567-574, 1955. 32. Lewison, E. F.: The Clinical Value of the Serum Amylase Test , Surg. Gynec. & Obst. 72: 202-212, 1941. 33. Howell, C. W., and Bergh, G. S.: Symposium on Pancreatic Disease: Pancreatic Duct Filling After Cholangiography; Its Effect on the Serum Amylase Levels , Gastroenterology 16:309-316, 1950. 34. Smith, J. L.; Walters, R. L., and Beal, J. M.: A Study of Choledochal Sphincter Action , Gastroenterology 20:129-137, 1952. 35. Butsch, W. L.; McGowan, J. M., and Walters, W.: Clinical Studies on the Influence of Certain Drugs in Relation to Biliary Pain and to the Variations in Intrabiliary Pressure , Surg. Gynec. & Obst. 63:451-456, 1936. 36. Myhre, J.; Nesbitt, S., and Hurly, J. T.: Response of Serum Amylase and Lipase to Pancreatic Stimulation as a Test of Pancreatic Function: Mecholyl-Secretin and Morphine-Secretin Tests , Gastroenterology 13:127-134, 1949. 37. Burke, J. O.; Plummer, K., and Bradford, S.: Serum Amylase Responses to Morphine, Mecholyl and Secretin as a Test of Pancreatic Function , Gastroenterology 15:699-707, 1950. 38. Gross, J. B.; Comfort, M. W.; Mathieson, D. R., and Power, M. H.: Elevated Values for Serum Amylase and Lipase Following Administration of Opiates: Preliminary Report , Proc. Staff Meet. Mayo Clin. 26:81-87, 1951. 39. Pfeffer, R. B.; Stephenson, H. E., Jr., and Hinton, J. W.: Effect of Morphine, Demerol and Codeine on Serum Amylase Values in Man , Gastroenterology 23:482-486, 1953. 40. Dunlop, G. A.: The Diastatic Index in Acute Parotitis , Lancet 2:183-184, 1933. 41. Candel, S., and Wheelock, M. C.: Serum Amylase and Serum Lipase in Mumps , Ann. Int. Med. 25:88-96, 1946.Crossref 42. Poppel, M. H., and Bercow, C.: The Roentgen Manifestations of Pancreatitis Complicating Mumps , Am. J. Roentgenol. 61:219-222, 1949. 43. Warren, W. R.: Serum Amylase and Lipase in Mumps , Am. J. M. Sc. 230:161-168, 1955.Crossref 44. Hinton, J. W.: Chronic Pancreatitis Associated with Peptic Ulcer , Arch. Surg. 28:580-588, 1934.Crossref 45. Pemberton, A. H.; Grindlay, J. H., and Bollman, J. L.: Serum Amylase Levels After Acute Perforations of the Duodenum: Preliminary Report , Proc. Staff Meet. Mayo Clin. 25:5-8, 1950. 46. Probstein, J. B.; Wheeler, P. A., and Gray, S. H.: Perforated Peptic Ulcer: Its Differentiation from Acute Pancreatitis by Blood Diastase Determination , J. Lab. & Clin. Med. 24:449-452, 1939. 47. Mahaffey, J. H.; Brockman, H. L.; Jordan, G. L., Jr., and Howard, J. M.: A Study of the Serum Amylase Concentration in Patients with Acute Perforation of Gastroduodenal Ulcers , Surg. Gynec. & Obst. 101:129-132, 1955. 48. Polowe, D.: Blood Amylase , Am. J. Clin. Path. 13:288-301, 1943. 49. Raffensperger, E. C.: Elevated Serum Pancreatic Enzyme Values Without Primary Intrinsic Pancreatic Disease , Ann. Int. Med. 35: 342-351, 1951. 50. Sachar, L. A.: A Simplified Laboratory Test for Acute Pancreatitis , Am. J. Clin. Path. 22:1117-1125, 1952. 51. Cherry, I. S., and Crandall, L. A.: The Specificity of Pancreatic Lipase: Its Appearance in the Blood After Pancreatic Injury , Am. J. Physiol. 100:266-273, 1932. 52. Ravin, H. A., and Seligman, A. M.: Determinants for the Specificity of Action of Pancreatic Lipase , Arch. Biochem. 42:337-354, 1953. 53. Loevenhart, A. S.: J. Biol. Chem. 2:391, 1907 54. Cherry and Crandall.50 55. Bunch, L. D., and Emerson, R. L.: Serum Lipase Determination: Four-Hour Technic with Olive Oil Substrate , Clin. Chem. 2:75-82, 1956. 56. Goldstein, N. P.; Epstein, J. H., and Roe, J. H.: Studies of Pancreatic Function: IV. A Simplified Method for the Determination of Serum Lipase, Using Aqueous Tributyrin as Substrate, with 100 Normal Values by This Method , J. Lab. & Clin. Med. 33:1047-1051, 1948. 57. Alper, C., and Polakoff, P. P., Jr.: Biochemical Studies on Pancreatic Function: Serum Lipase Activity , Fed. Proc. 10:155, 1951. 58. Seligman, A. M., and Nachlas, M. M.: The Colorimetric Determination of Lipase and Esterase in Human Serum , J. Clin. Invest. 29:31-36, 1950. 59. Johnson, T. A., and Bockus, H. L.: Diagnostic Significance of Determinations of Serum Lipase , Arch. Int. Med. 66:62-77, 1940. 60. Comfort, M. H., and Osterberg, A. E.: The Value of Determination of the Concentration of Serum Amylase and Serum Lipase in the Diagnosis of Disease of the Pancreas , Proc. Staff Meet. Mayo Clin. 15:427, 1940. 61. Bockus, H. L., and Raffensperger, E. C.: Acute Pancreatitis , New York J. Med. 48:2252-2259, 1948. 62. Johnson, T. A., and Bockus, H. L.: The Present Status of the Serum Lipase Test , Am. J. Digest. Dis. 10:1-7, 1943.Crossref 63. Cummins, A. J., and Bockus, H. L.: Abnormal Serum Pancreatic Enzyme Values in Liver Disease , Gastroenterology 18:518-529, 1951. 64. Johnstone, P. N.; Clasen, A. C., and Orr, T. G.: The Role of the External Secretion of the Pancreas in Experimental High Intestinal Obstruction , Surg. Gynec. & Obst. 57:483-486, 1933. 65. Wapshaw, H.: The Pancreatic Side-Effects of Morphine , Brit. M. J. 1:373-375, 1953. 66. Bogoch, A.; Roth, J. L. A., and Bockus, H. L.: The Effects of Morphine on Serum Amylase and Lipase , Gastroenterology 26:697-708, 1954. 67. Tagnon, H. J.: The Nature of the Mechanism of the Shock Produced by the Injection of Trypsin and Thrombin , J. Clin. Invest. 24:1-10, 1945. 68. Innerfield, I.; Schwartz, A. W., and Angrist, A. A.: Fibrinolytic and Anticoagulant Effects of Intravenous Crystalline Trypsin , Bull. New York Acad. Med. 28:537-538, 1952. 69. Innerfield, I.; Angrist, A., and Benjamin, J. W.: Plasma Antithrombin Patterns in Disturbances of the Pancreas , Gastroenterology 19: 843-854, 1951. 70. Quick, A. J.: The Normal Antithrombin of the Blood and Its Relation to Heparin , Am. J. Physiol. 123:712-719, 1938. 71. Innerfield, I.; Angrist, A., and Benjamin, J. W.: The Antithrombin Titer in Acute Pancreatitis , Bull. New York Acad. Med. 27:399-400, 1951. 72. Innerfield, I.; Angrist, A., and Benjamin, J. W.: The Antithrombin Titer in Cystic Fibrosis of the Pancreas: Preliminary Report , J. Pediat. 39:287-297, 1951. 73. Innerfield, I.; Angrist, A., and Benjamin, J. W.: Antithrombin Titer in Acute Pancreatitis , Am. J. Med. 12:24-33, 1952. 74. Innerfield, I., and Angrist, A.: The Plasma Antithrombin Determination: A New Test for Cancer of the Pancreas Associated with Jaundice , Am. J. M. Sc. 223:422-428, 1952. 75. Innerfield, I.; Angrist, A., and Benjamin, J. W.: The Antithrombin Titer in Pancreatic Cyst , Am. J. Surg. 83:538-543, 1952. 76. Innerfield, I.: Acute Pancreatitis: The Antithrombin Titer as an Aid in Diagnosis and Prognosis , New York J. Med. 52:2239-2243, 1952. 77. Moseley, V.; Seymour, W., and Pappas, A.: Some Observations on the Plasma Antithrombin Test as a Diagnostic Aid , South. M. J. 47:476-484, 1954. 78. Moseley, V., in discussion on Reference 3, p. 328. 79. Griffith, W. H.: Plasma Antithrombin in Thrombosis, Hemorrhage, and Liver Disease , J. Lab. & Clin. Med. 40:367-373, 1952. 80. Welch, G. E., in discussion on Reference 75, p. 483. 81. Levy, J. A., in discussion on Reference 75, p. 483. 82. Dreiling, D. A.; Greenspan, E. M., and Sanders, M.: A Correlative Study of the External Pancreatic Secretion, the Plasma Antithrombin Titer, the Blood Amylase Concentration, and the Serum Mucoprotein Level in Patients With and Without Pancreatic Disease , Gastroenterology 27: 755-765, 1954. 83. Knight, W. A., Jr.; Muether, R. O., and Sommer, A. J.: Chronic Recurrent Pancreatitis: II. Serial Serum Diastase Levels Following Prostigmine Stimulation , Gastroenterology 12:34-48, 1949. 84. Malinowski, T. S.: Serum Amylase Response to Pancreatic Stimulation as a Test of Pancreatic Disease , Am. J. M. Sc. 222:440-445, 1951. 85. Lagerlof, H. O.: Normal Esterases and Pancreatic Lipase in the Blood: A Study with New Chemical and Clinical Methods , Acta. med. scandinav. 120:407-436, 1945.Crossref 86. Wirts, C. W., and Snape, W. J.: Evaluation of Pancreatic Function Tests , J. A. M. A. 145: 876-879, 1951.Crossref 87. Lopusniak, M. S., and Bockus, H. L.: Symposium on Pancreatic Disease: A Study of Pancreatic Serum Enzymes Following Secretin Injection in Pancreatic Affections , Gastroenterology 16:294-308, 1950. 88. Sanchez-Ubeda, R., and Rousselot, L. M.: Serum Enzymatic Response (Diastase and Lipase) After Stimulation of External Pancreatic Secretion with Secretin and Methacholine: Preliminary Report , Surg. Gynec. & Obst. 93:283-291, 1951. 89. Heffernon, E. W., and Gunter, A. R.: Evaluation of the Secretin Test in Pancreatic Disease , Gastroenterology 19:526-532, 1951. 90. Dreiling, D. A., and Richman, A.: Evaluation of Provocative Blood Enzyme Tests Employed in Diagnosis of Pancreatic Disease , A. M. A. Arch. Int. Med. 94:197-212, 1954. 91. Shingleton, W. W.; Anlyan, W. G., and Hart, D.: The Diagnosis of Pancreatic Disorders by Certain Laboratory Procedures , Ann. Surg. 136:578-584, 1952. 92. Warren, K. W.; Fallis, L. S., and Barron, J.: Acute Pancreatitis and Diabetes , Ann. Surg. 132:1103-1110, 1950. 93. Althausen, T. L., and Uyeyama, K.: A New Test of Pancreatic Function Based on Starch Tolerance , Ann. Int. Med. 41:563-575, 1954. 94. Maimon, S. N.; Kirsner, J. B., and Palmer, W. L.: Chronic Recurrent Pancreatitis: A Clinical Study of 20 Cases , Arch. Int. Med. 81:56-72, 1948. 95. Comfort, M. W.; Gambill, E. E., and Bagenstoss, A. H.: Chronic Relapsing Pancreatitis: Study of 29 Cases Without Associated Disease of Biliary or Gastrointestinal Tract , Gastroenterology 6:239-285 and 376-408, 1946. 96. King, S. E.: The Syndrome of Chronic Relapsing Pancreatitis: The Frequency of Insular Deficiency (Pancreatic Diabetes) in the Fibrocalcific State , M. Clin. North America 33:883-897, 1949. 97. Berk, J. E.: Diagnosis of Carcinoma of the Pancreas , Arch. Int. Med. 68:525-559, 1941. 98. Knight, W. A., Jr., and Muether, R. O.: Carcinoma of the Pancreas: The Comparison of Clinical and Laboratory Findings of Carcinoma of the Pancreas and Chronic Pancreatitis , South. M. J. 46:660-667, 1953. 99. Dashiell, G. F., and Palmer, W. L.: Carcinoma of the Pancreas: Diagnostic Criteria , Arch. Int. Med. 81:173-183, 1948. 100. Bockus, H. L., in discussion on Reference 96, p. 666. 101. Sohmer, M. F., and Cayer, D.: Cancer of the Pancreas Without Jaundice , South. M. J. 48: 919-925, 1955. 102. Leveaux, V. M.: The Diagnosis of Carcinoma of the Pancreas , Brit. J. Cancer 8:427-433, 1954. 103. Edmondson, H. A., and Berne, C. J.: Calcium Changes in Acute Pancreatic Necrosis , Surg. Gynec. & Obst. 79:240-244, 1944. 104. Edmondson, H. A.; Berne, C. J.; Homann, R. E., Jr., and Wertman, M.: Calcium, Potassium, Magnesium and Amylase Disturbances in Acute Pancreatitis , Am. J. Med. 12:34-42, 1952. 105. Kimble, M. S.: The Determination of Blood Carotene and Vitamin A , J. Lab. & Clin. Med. 24:1055-1065, 1939. 106. Wenger, J.: Blood Carotene and Steatorrhea , Clin. Res. Proc. 4:133, 1956. 107. Wenger, J.; Kirsner, J. B., and Palmer, W. L.: Blood Carotene in Steatorrhea and the Malabsorptive Syndromes , Am. J. Med. 22:373-380, 1957.Crossref 108. Pratt, J. H.: A Study of Steatorrhea with Special Reference to Its Occurrence in Pancreatic Disease and Sprue , Am. J. M. Sc. 187:222-235, 1934.Crossref 109. Kowlessar, O. D., and McEvoy, R. K.: Desoxyribonuclease I Activity in Pancreatic Disease , J. Clin. Invest. 35:1325-1330, 1956.Crossref 110. Allfrey, V. G., and Mirsky, A. E.: Some Aspects of the Desoxyribonuclease Activities of Animal Tissues , J. Gen. Physiol. 36:227-241, 1952.Crossref 111. Dozzi, D. L.: Urinary Amylase: Its Estimation and Its Significance , Am. J. Digest. Dis. 7: 123-133, 1940.Crossref 112. Dozzi, D. L.: Evaluation of Methods for Determining Blood and Urinary Amylase , J. Lab. & Clin. Med. 25:1303-1308, 1940. 113. Saxon, E. I.; Hinkley, W. C.; Vogel, W. C., and Zieve, L.: Comparative Value of Serum and Urinary Amylase in the Diagnosis of Acute Pancreatitis , Clin. Res. Proc. 4:132, 1956. 114. Saxon, E. I.; Hinkley, W. C.; Vogel, W. C., and Zieve, L.: Comparative Value of Serum and Urinary Amylase in the Diagnosis of Acute Pancreatitis , A. M. A. Arch. Int. Med. 99:607-621, 1957. 115. Nothman, M. M.; Pratt, J. H., and Callow, A. D.: Studies on Urinary Lipase: I. On a Fat-Splitting Enzyme in Urine and Its Relation to Pancreas , A. M. A. Arch. Int. Med. 95:224-230, 1955. 116. Nothman, M. M.; Pratt, J. H., and Callow, A. D.: Studies on Urinary Lipase: II. Urinary Lipase in Man , A. M. A. Arch. Int. Med. 96:188-190, 1955. 117. Nothman, M. M.: The Value of Functional Tests for the Diagnosis of Diseases of the Pancreas , Ann. Int. Med. 34:1358-1371, 1951. 118. van de Kamer, J. H.; ten Bokkel Huinink, H., and Weyers, H. A.: Rapid Method for the Determination of Fat in Feces , J. Biol. Chem. 177:347-355, 1949. 119. Cooke, W. T.; Elkes, J. J.; Frazer, A. C.; Parkes, J.; Peeney, A. L. P.; Sammons, H. G., and Thomas, G.: Anomalies of Intestinal Absorption of Fat: The Determination and Significance of Foecal Fat , Quart. J. Med. 39:141-155, 1946. 120. Beres, P.; Wenger, J., and Kirsner, J. B.: The Use of I131 Triolein in the Study of Absorptive Disorders in Man , Gastroenterology 32:1-16, 1957. 121. Comfort, M. W.; Wollaeger, E. E.; Taylor, A. B., and Power, M. H.: Nontropical Sprue: Observations on Absorption and Metabolism , Gastroenterology 23:155-178, 1953. 122. Johnstone, D. E.: Studies in Cystic Fibrosis of the Pancreas: Role of Various Diluents and the Dilution Factor in the Interpretation of the X-Ray Film Test for Fecal Trypsin , A. M. A. Am. J. Dis. Child. 84:191-198, 1952. 123. Chinn, A. B.; Lavik, P. S.; Stitt, R. M., and Buckaloo, G. W.: Use of I131-Labeled Protein in the Diagnosis of Pancreatic Insufficiency , New England J. Med. 247:877-880, 1952. 124. May, C. D.; Blackfan, K. D.; McCreary, J. F., and Allen, F. H., Jr.: Clinical Studies of Vitamin A in Infants and in Children , Am. J. Dis. Child. 59:1167-1184, 1940. 125. Adlersberg, D., and Sobotka, H.: Fat and Vitamin A Absorption in Sprue and Jejuno-Ileitis , Gastroenterology 1:357-365, 1943. 126. Legerton, C. W., Jr.; Texter, E. C., Jr., and Ruffin, J. M.: Observations on the Vitamin A Tolerance Curve as an Index of the Degree of Fat Absorption , Gastroenterology 23:477-481, 1953. 127. Frazer, A. C., and Steward, H. C.: The Interpretation of the Normal Chylomicrograph , J. Physiol. 95:23P, 1939. 128. West, C. D.; Wilson, J. L., and Eyles, R.: Blood Amino Nitrogen Levels: Changes in Blood Amino Nitrogen Levels Following Ingestion of Proteins and of Protein Hydrolysate in Infants with Normal and with Deficient Pancreatic Function , Am. J. Dis. Child. 72:251-273, 1946.Crossref 129. Kalser, M. H.: Comparison of the Glucose and Starch Tolerances, the Secretin Test, and Fecal Balance Studies in Patients with Pancreatic Disease, presented at the Panamerican Congress of Gastroenterology, Havana, Cuba, January, 1956. 130. Fourman, L. P. R.: The Absorption of Xylose in Steatorrhea , Clin. Sc. 6:289-294, 1948. 131. Benson, J. A., Jr.; Culver, P. J.; Ragland, S.; Jones, C. M.; Drummey, G. D., and Bougas, E.: The D-Xylose Absorption Test in Malabsorp- tion Syndromes , New England J. Med. 256:335-339, 1957.Crossref 132. Shingleton, W. W.; Wells, M. H.; Baylin, G. J.; Ruffin, J. M., and Saunders, A.: The Use of Radioactive-Labeled Protein and Fat in the Evaluation of Pancreatic Disorders , Surgery 38: 134-142, 1955. 133. Shingleton, W. W.; Baylin, G. J.; Isley, J. K.; Sanders, A. P., and Ruffin, J. M.: The Evaluation of Pancreatic Function by the Use of I131 Labeled Fat , Gastroenterology 32:28-33, 1957. 134. Beres, P., in discussion on Reference 133, p. 27. 135. McKenna, R. D.; Bourne, R. H., and Matzko, A.: The Use of I131 Labeled Fat in Study of Fat Digestion and Absorption in Normal Individuals and in Patients with Diseases of Fat Absorption , Gastroenterology 32:17-27, 1957. 136. Ruffin, J. M., in discussion on Reference 133, p. 26. 137. Volwiler, W., in discussion on Reference 133, p. 25. 138. Nardi, G. L.: Phospholipid Synthesis in Patients with Pancreatic Disease: Radioactive Phosphorous as Measure , A. M. A. Arch. Surg. 69:726-731, 1954.Crossref 139. Barker, W. F.; Rogers, K. E., and Moore, F. D.: Effect of Pancreatectomy on Phospholipid Synthesis in the Dog , Arch. Surg. 61:1151-1162, 1950.Crossref 140. Agren, G.; Lagerlof, H., and Berglund, H.: The Secretin Test of Pancreatic Function in the Diagnosis of Pancreatic Disease , Acta. med. scandinav. 90:224-271, 1936.Crossref 141. Kyle, G. C.; Machella, T. E.; Lorber, S. H.; Hilsman, J. T.; Reinhold, J. G., and Brown, J. C.: Symposium on Pancreatic Disease, The Use of Urecholine as a Stimulant of External Secretion of the Pancreas , Gastroenterology 16:285-293, 1950. 142. Comfort, M. W., and Osterberg, A. E.: Pancreatic Secretion in Man After Stimulation with Secretin and Acetylbetamethylcholine Chloride: A Comparative Study , Arch. Int. Med. 66: 688-706, 1940.Crossref 143. Diamond, J. S., and Siegal, S. A.: The Secretin Test in the Diagnosis of Pancreatic Disease with a Report of 130 Tests , Am. J. Digest. Dis. 7:435-442, 1940.Crossref 144. Friedman, M. H. F., and Snape, W. J.: Pancreatic Secretion in Man in Response to Administration of Secretin and Insulin , Fed. Proc. 6:107, 1947. 145. Pollard, H. M.; Miller, L., and Brewer, W. A.: A Clinical Study of the Secretin Test , Am. J. Digest. Dis. 9:68-73, 1942.Crossref 146. Lake, M.: Diagnostic Value of the Secretin Test, Including a Report of Nineteen Operated or Autopsied Cases with Anatomical Studies of the Pancreas , Am. J. Med. 3:18-30, 1947.Crossref 147. Doubilet, H.: Value of the Secretin Test in Surgery , S. Clin. North America 29:489-499, 1949. 148. Dreiling, D. A., and Hollander, F.: Studies in Pancreatic Function: I. Preliminary Series of Clinical Studies with the Secretin Test , Gastroenterology 11:714-729, 1948. 149. Dreiling, D. A., and Hollander, F.: Studies in Pancreatic Function: II. A Statistical Study of Pancreatic Secretion Following Secretin in Patients Without Pancreatic Disease , Gastroenterology 15:620-627, 1950. 150. Dreiling, D. A.: The Technique of the Secretin Test: Normal Ranges , J. Mt. Sinai Hosp. New York 21:363-372, 1955. 151. Dreiling, D. A. Studies in Pancreatic Function: IV. The Use of the Secretin Test in the Diagnosis of Tumors In and About the Pancreas , Gastroenterology 18:184-196, 1951. 152. Dreiling, D. A.: Studies in Pancreatic Function: V. The Use of the Secretin Test in the Diagnosis of Pancreatitis and in the Demonstration of Pancreatic Insufficiencies in Gastrointestinal Disorders , Gastroenterology 24:540-555, 1953. 153. Menguy, R. B.; Grindlay, J. H., and Cain, J. C.: The Effects of Chlorpromazine Hydrochloride on the Dynamics of the Biliary Tree: An Experimental Study , Gastroenterology 30:752-757, 1956. 154. Personal observations by the authors. 155. Dreiling, D. A.; Janowitz, H. D., and Halpern, M.: The Effect of a Carbonic Anhydrase Inhibitor, Diamox, on Human Pancreatic Secretion: Implications on the Mechanism of Pancreatic Secretion , Gastroenterology 29:262-279, 1955. 156. Sun, D. C. H., and Shay, H.: Value of Combined Study of Serum Enzymes and Duodenal Contents After Secretin in the Diagnosis of Diseases of the Pancreas , Gastroenterology 32:212-231, 1957. 157. Dreiling, D. A., and Lipsay, J. 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The Laboratory Diagnosis of Pancreatic Disease

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American Medical Association
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Copyright © 1958 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1958.00260130128014
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Abstract

Abstract The diagnosis of pancreatic disease is gradually improving, largely as a result of increasing experience in correlating laboratory data reflecting normal and altered physiologic function and newer techniques for assessing the digestive capacity of pancreatic enzymes. Characteristic alterations of the quantity and constituents of the duodenal content have been established. These refinements have emphasized the importance of adequate understanding of the type, mechanism, and application of pancreatic function tests. In the present discussion these procedures are classified with respect to the moiety analyzed or the specific function evaluated (Table 1). Determinations of Blood or Serum Constituents A. Serum Amylase. —Since Elman and his associates,9 in 1929, confirmed the presence of an increased serum amylase activity in inflammation or obstruction of the pancreatic duct, this analysis has become the most widely applied test of pancreatic disease. 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M., in discussion on Reference 133, p. 26. 137. Volwiler, W., in discussion on Reference 133, p. 25. 138. Nardi, G. L.: Phospholipid Synthesis in Patients with Pancreatic Disease: Radioactive Phosphorous as Measure , A. M. A. Arch. Surg. 69:726-731, 1954.Crossref 139. Barker, W. F.; Rogers, K. E., and Moore, F. D.: Effect of Pancreatectomy on Phospholipid Synthesis in the Dog , Arch. Surg. 61:1151-1162, 1950.Crossref 140. Agren, G.; Lagerlof, H., and Berglund, H.: The Secretin Test of Pancreatic Function in the Diagnosis of Pancreatic Disease , Acta. med. scandinav. 90:224-271, 1936.Crossref 141. Kyle, G. C.; Machella, T. E.; Lorber, S. H.; Hilsman, J. T.; Reinhold, J. G., and Brown, J. C.: Symposium on Pancreatic Disease, The Use of Urecholine as a Stimulant of External Secretion of the Pancreas , Gastroenterology 16:285-293, 1950. 142. Comfort, M. W., and Osterberg, A. E.: Pancreatic Secretion in Man After Stimulation with Secretin and Acetylbetamethylcholine Chloride: A Comparative Study , Arch. Int. Med. 66: 688-706, 1940.Crossref 143. Diamond, J. S., and Siegal, S. A.: The Secretin Test in the Diagnosis of Pancreatic Disease with a Report of 130 Tests , Am. J. Digest. Dis. 7:435-442, 1940.Crossref 144. Friedman, M. H. F., and Snape, W. J.: Pancreatic Secretion in Man in Response to Administration of Secretin and Insulin , Fed. Proc. 6:107, 1947. 145. Pollard, H. M.; Miller, L., and Brewer, W. A.: A Clinical Study of the Secretin Test , Am. J. Digest. Dis. 9:68-73, 1942.Crossref 146. Lake, M.: Diagnostic Value of the Secretin Test, Including a Report of Nineteen Operated or Autopsied Cases with Anatomical Studies of the Pancreas , Am. J. Med. 3:18-30, 1947.Crossref 147. Doubilet, H.: Value of the Secretin Test in Surgery , S. Clin. North America 29:489-499, 1949. 148. Dreiling, D. A., and Hollander, F.: Studies in Pancreatic Function: I. Preliminary Series of Clinical Studies with the Secretin Test , Gastroenterology 11:714-729, 1948. 149. Dreiling, D. A., and Hollander, F.: Studies in Pancreatic Function: II. A Statistical Study of Pancreatic Secretion Following Secretin in Patients Without Pancreatic Disease , Gastroenterology 15:620-627, 1950. 150. Dreiling, D. A.: The Technique of the Secretin Test: Normal Ranges , J. Mt. Sinai Hosp. New York 21:363-372, 1955. 151. Dreiling, D. A. Studies in Pancreatic Function: IV. The Use of the Secretin Test in the Diagnosis of Tumors In and About the Pancreas , Gastroenterology 18:184-196, 1951. 152. Dreiling, D. A.: Studies in Pancreatic Function: V. The Use of the Secretin Test in the Diagnosis of Pancreatitis and in the Demonstration of Pancreatic Insufficiencies in Gastrointestinal Disorders , Gastroenterology 24:540-555, 1953. 153. Menguy, R. B.; Grindlay, J. H., and Cain, J. C.: The Effects of Chlorpromazine Hydrochloride on the Dynamics of the Biliary Tree: An Experimental Study , Gastroenterology 30:752-757, 1956. 154. Personal observations by the authors. 155. Dreiling, D. A.; Janowitz, H. D., and Halpern, M.: The Effect of a Carbonic Anhydrase Inhibitor, Diamox, on Human Pancreatic Secretion: Implications on the Mechanism of Pancreatic Secretion , Gastroenterology 29:262-279, 1955. 156. Sun, D. C. H., and Shay, H.: Value of Combined Study of Serum Enzymes and Duodenal Contents After Secretin in the Diagnosis of Diseases of the Pancreas , Gastroenterology 32:212-231, 1957. 157. Dreiling, D. A., and Lipsay, J. J.: The Use of the Secretin Test in the Diagnosis of Biliary Tract Disease: Report of 327 Case Studies , Gastroenterology 17:242-259, 1951. 158. Lans, H. S.; Stein, I. F., Jr., and Meyer, K. A.: Function Tests in the Diagnosis of Biliary Tract Disease Using Sodium Dehydrocholate or Secretin , Gastroenterology 18:64-78, 1951. 159. Dreiling, D. A.: Studies of Pancreatic Function: III. The Use of the Secretin Test in the Diagnosis of Patients with the Post-Cholecystectomy Syndrome , Gastroenterology 16:162-171, 1950. 160. Raskin, H. F.: Personal communication to the authors, January, 1957; data to be published.

Journal

A.M.A. Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1958

References