INVESTIGATIONS Estimation of pancreatic enzymes in

INVESTIGATIONS Estimation of pancreatic enzymes in body fluids

Investigations of the pancreas are listed in Table 72.2 . When the pancreas is damaged, enzymes such as amylase, lipase, trypsin, elastase and chymotrypsin are released into the serum. Measurement of serum amylase is the most widely used test of pancreatic damage (serum lipase is more sensitive and specific but is not widely av ailable). The serum amylase rises within a few hours of pancreatic damage and declines over the next 4–8 days. A markedly elevated serum level is highly suspi - cious but not diagnostic of acute pancreatitis. Urinary amylase and amylase–creatinine clearance ratios add little to diagnostic accuracy . If confirmation of the diagnosis is required, com - puted tomography (CT) of the pancreas is of greater value. Summary box 72.2 Causes of raised serum amylase level other than acute pancreatitis /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Upper gastrointestinal tract perforation Mesenteric infarction Torsion of an intra-abdominal viscus Retroperitoneal haematoma Ectopic pregnancy Macroamylasaemia Renal failure Salivary gland in /f_l ammation