The pancreatic enzymes value in the diagnosis of acute pancreatitis and acute biliary tract diseases.

UNLABELLED: The aim of this study was to investigate the usefulness of lipase and isoamylases in the diagnosis of acute pancreatitis and to determine if its use permits differential diagnosis between acute pancreatitis and acute biliary tract disease. Three groups of patients were studied. a) CONTROL: 60 patients without abdominal diseases. b) Acute pancreatitis: 60 patients, the diagnosis was made according to clinical symptoms, biochemical tests, U.S. and C.T. in 24 (40%), in the remainder 36 (60%) surgical confirmation was obtained. c) Acute biliary tract disease without macroscopic pancreatic damage, 30 patients, the diagnosis was made according to biochemical tests and U.S. in 4 (13.3%) whereas in the remainder 26 (86.6%) surgical confirmation was accomplished no later than a week of the beginning of the symptoms. Biochemical tests: serum and urine amylase, lipase, and total pancreatic and salivary isoamylases were evaluated. In the group of acute pancreatitis the highest diagnostic sensibility was: pancreatic isoamylase 95.5%, lipase 95%, total serum amylase 93.3% urine amylase 90%, serum amylase 78.3%. In acute biliary tract diseases a high number of elevated enzyme values were also found: pancreatic isoamylase 83.3%, total isoamylase 73.3%, urine amylase 66.6%, lipase 63.3%, serum amylase 53.3%. The mean enzyme values of both groups were compared statistically and showed no significant difference. We conclude that lipase and isoamylases are the best markers for the diagnosis of acute pancreatitis and the differential diagnosis with acute biliary diseases is difficult because an elevation of these enzymes is a characteristic shared by both pathologies. The diagnosis of acute pancreatitis based only in clinical symptoms and hyperamylasemia can be erroneous.

[Value of laboratory tests and echography in the diagnosis of biliary disease in the initial phase of acute pancreatitis]. / Valor de las pruebas de laboratorio y ecografía en el diagnóstico de la patología biliar en el período inicial de la pancreatitis aguda.

The aim of this study was to investigate the usefulness of serum bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (APh) and real time ultrasonography (US) in distinguishing between gallstone and non gallstone related acute pancreatitis (A.P.). The second aim was to evaluate whether or nor there was biliary tract hypertension. Both aims were designed in order to evaluate them in the early stage of A.P. Two Groups of patients were studied. Group 1--gallstone related A.P., 63 pts. Group 2--Non gallstone related A.P. 21 pts. Fifty nine (93.6%) of Group 1 and 11 (52.3%) of Group 2 had surgical confirmation. In the other, the diagnosis was based on US and C.T. Blood samples were taken during the three days after admission for biochemical test and US was performed within the same period. Statistical evaluation and Student's t test were used. Biochemical test: when the cut off level was expressed by the upper limit of normal (ULN), the highest diagnostic sensibility was (table 1): ALT 85.7%, APH 80.9%. AST 71%, bilirubin 65%. When the cut off level was chosen at twice the ULN (Table 1), the sensibility was: ALT 61.9%, bilirubin and AST 47%, APh 30%, Group 2 (Table 2) values higher than the ULN were: AST 42.8%, bilirubin 33%, ALT 19%, APh 14.2%. The differences between the two Groups were statistically significant: APh and bilirubin P less than 0.001, ALT less than 0.05 m AST, NS. Ultrasonography: Group 1: gallstones were detected in 96.6% (58/60). Biliary tree was not visualized in 10 (15.8%), diagnosed as normal in 38 (60.3%) and pathologic (dilatation and/or lithiasis) in 15 (23.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronic calcified pancreatitis. Our experience]. / Pancreatitis crónica calcificada. Nuestra experiencia.

Forty five cases of chronic pancreatitis have been diagnosed between January 1966 to July 1983 in the Hospital A. Posadas. The diagnosis was confirmed by the presence of one or more of the following data: pancreatic calcifications positive in 35, abnormal secretin test 37, ultrasonography and computed tomography pathological findings 10. Surgical operations were carried out in 25 patients and biopsy taken in 5. Thirty nine (86.6%) were males, 6 (13.3%) females, the mean age in each group was 47.4 and 39.8 years. Chronic alcoholism was certain in 41 (91.9) patients, in the remainder 4 no other etiologic factors were found. The main clinical data were: Weight loss 38 (84.4%) diabetes 34 (75.5%) pain 33 (73.3% in 7 as acute pancreatitis) Steatorrhea 23 (51.1%) jaundice 16 (35.5%- 11 by extrahepatic biliary tree obstruction, 5 by hepatic cirrhosis) pseudocysts 12 (26.6%). The more common associated diseases were: hepatic cirrhosis 6, fatty liver 2 (17.7%) gastroduodenal ulcer 6 (13.3%) cancer 4 (8.8%--gastric 1, pancreatic 3). In order to study the frequency of the clinical data the patients were grouped according to the presence or absence of calcifications and the etiologic factor Symptoms and signs were matched and statistic analysis (coefficient association phi) was made. Only a moderate association between acute pancreatitis in no calcified group and diabetes in calcified group were found. The chronologic study of certains clinical data shows that acute pancreatitis, jaundice, pseudo-cyst and surgical operations were significative more frequent in the first five years while diabetes has little more frequency in the second five year period. Twenty six surgical operations were carried out in 25 patients; 20 (76.9%) due to complications, 6 (23.1%) secondary to pain (pancreatic resection 3, pancreatoyeyunostomy 2, exploration 1). Twenty three patients were lost to follow-up, 12 died and 10 are still alive. This last group was followed at regular period, 8 remained asymptomatic and 2 have intermittent abdominal pain related to alcoholic ingestion.

[Acute pancreatitis. Our experience]. / Pancreatitis aguda. Nuestra experiencia.

Between the years 1975 and 1984, 228 patients with acute pancreatitis (A.P.) have been studied at the "A. Posadas Hospital". The diagnosis was confirmed in 212 patients by surgery, in the remaining 16 by clinical evaluation, increase in the activity of serum or peritoneal fluid amylase, ultra-sonography and computed tomography. The sex distribution was: female 151 (66.2%) male 77 (33.8%), the mean age in each group was 42.9 and 45 years respectively. The etiologic factors were: biliary tract disease 178 (78%) alcohol 24 (10.5%) idiopathic 16 (7%) others factors 10 (4.4%). We found mild and moderate forms of the illness in 179 (78.5%) and severe form in 49 (21.5%) patients. The mortality rate of the whole group was 29 (12.7%) and according to the etiology it was, in the biliary group 20 (11.2%) alcoholic 4 (16.6%) idiopathic 3 (18.7%). The mortality in the mild and moderate forms was 5% and 40.8% in the severe forms. The patients who underwent surgery were classified in three groups according to the opportunity of surgical treatment: elective surgery, early surgery, surgery for complications. There was no mortality in the elective surgery group. The patients operated on early period had a mortality of 18.75% (21 pts.) whereas those operated due to complications had a mortality of 42.1% (8 pts.). According to the above mentioned experience we consider that a patient with an A.P. must be classified with the known indexes in mild or severe forms, at the same time one should study the actual etiologic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

The pancreatic enzymes value in the diagnosis of acute pancreatitis and acute biliary tract diseases

El objetivo del presente trabajo fué investigar la utilidad de la determinación de lipasa e isoamilasas en el diagnóstico de pancreatitis aguda, compárandolas con la de amilasa y si la evaluación de estas enzimas permite el diagnóstico clínicos diferencial entre pancreatitis aguda y patología biliar aguda sin lesión pancreática. Se estudiaron tres grupos de pacientes. a) Control: 60 pacientes sin enfermedades digestivas. b) Pancreatitis aguda: 60 pacientes, en las que el diagnóstico fue hecho en base al cuadro clínico, análisis de laboratorio, ecografia y T. C. em 24 (40%), en las restantes 36(60%), se obtuvo además confirmación quirúrgica, c) Patología biliar aguda sin daño macroscópico pancreático, 30 pacientes en los que el diagnóstico se hizo de acuerdo al cuadro clínico, análisis de laboratorio y ecografia en 4 (13,3%) mientras que en los restantes 26(86,6%) se obtuvo confirmación quirúrgica, dentro de la semana de haber comenzado el cuadro clínico. En todos los pacientes se determinaram: amilasa en suero y orina, lipasa e isoamilasas total, pancreática y salival en suero. En el grupo con pancreatitis aguda, la sensibilidad diagnóstica fue: isoamilasa pancreática 95,5%, lipasa 95%, amilasa sérica total 93,3%, amilasuria 90%, amilasemia 78,3%. En el grupo de patología aguda biliar, sin daño pancreático, se encontraron también un número elevado de valores de las enzimas: isoamilasa pancreática 83,3%, amilasa sérica total 73,3%, amilasuria 66,6% lipasemia 63,3% amilasemia 53,3%..

The pancreatic enzymes value in the diagnosis of acute pancreatitis and acute biliary tract diseases

El objetivo del presente trabajo fué investigar la utilidad de la determinación de lipasa e isoamilasas en el diagnóstico de pancreatitis aguda, compárandolas con la de amilasa y si la evaluación de estas enzimas permite el diagnóstico clínicos diferencial entre pancreatitis aguda y patología biliar aguda sin lesión pancreática. Se estudiaron tres grupos de pacientes. a) Control: 60 pacientes sin enfermedades digestivas. b) Pancreatitis aguda: 60 pacientes, en las que el diagnóstico fue hecho en base al cuadro clínico, análisis de laboratorio, ecografia y T. C. em 24 (40%), en las restantes 36(60%), se obtuvo además confirmación quirúrgica, c) Patología biliar aguda sin daño macroscópico pancreático, 30 pacientes en los que el diagnóstico se hizo de acuerdo al cuadro clínico, análisis de laboratorio y ecografia en 4 (13,3%) mientras que en los restantes 26(86,6%) se obtuvo confirmación quirúrgica, dentro de la semana de haber comenzado el cuadro clínico. En todos los pacientes se determinaram: amilasa en suero y orina, lipasa e isoamilasas total, pancreática y salival en suero. En el grupo con pancreatitis aguda, la sensibilidad diagnóstica fue: isoamilasa pancreática 95,5%, lipasa 95%, amilasa sérica total 93,3%, amilasuria 90%, amilasemia 78,3%. En el grupo de patología aguda biliar, sin daño pancreático, se encontraron también un número elevado de valores de las enzimas: isoamilasa pancreática 83,3%, amilasa sérica total 73,3%, amilasuria 66,6% lipasemia 63,3% amilasemia 53,3%..

The pancreatic enzymes value in the diagnosis of acute pancreatitis and acute biliary tract diseases.

The aim of this study was to investigate the usefulness of lipase and isoamylases in the diagnosis of acute pancreatitis and to determine if its use permits differential diagnosis between acute pancreatitis and acute biliary tract disease. Three groups of patients were studied. a) Control: 60 patients without abdominal diseases. b) Acute pancreatitis: 60 patients, the diagnosis was made according to clinical symptoms, biochemical tests, U.S. and C.T. in 24 (40

), in the remainder 36 (60

) surgical confirmation was obtained. c) Acute biliary tract disease without macroscopic pancreatic damage, 30 patients, the diagnosis was made according to biochemical tests and U.S. in 4 (13.3

) whereas in the remainder 26 (86.6

) surgical confirmation was accomplished no later than a week of the beginning of the symptoms. Biochemical tests: serum and urine amylase, lipase, and total pancreatic and salivary isoamylases were evaluated. In the group of acute pancreatitis the highest diagnostic sensibility was: pancreatic isoamylase 95.5

, lipase 95

, total serum amylase 93.3

urine amylase 90

, serum amylase 78.3

. In acute biliary tract diseases a high number of elevated enzyme values were also found: pancreatic isoamylase 83.3

, total isoamylase 73.3

, urine amylase 66.6

, lipase 63.3

, serum amylase 53.3

. The mean enzyme values of both groups were compared statistically and showed no significant difference. We conclude that lipase and isoamylases are the best markers for the diagnosis of acute pancreatitis and the differential diagnosis with acute biliary diseases is difficult because an elevation of these enzymes is a characteristic shared by both pathologies. The diagnosis of acute pancreatitis based only in clinical symptoms and hyperamylasemia can be erroneous.

Pancreatitis aguda: nuestra experiencia / Acute pancreatitis: our experience

Se estudiaron 228 pacientes con pancreatitis aguda internados en el Hospital Nacional Prof. A. Posadas, entre los años 1975-1984. El diagnóstico se confirmó en 212 por cirugía y en los restantes 16 por el cuadro clínico, elevación de amilasa en suero y líquido peritoneal; ecografía y tomografia computada. Pertenecieron al sexo femenino 151 (66,2%), al masculino 77 (33,8%) con edad promedio de 42,9 y 45 años respectivamente. La etiología fue: Patología biliar 178 (78%)alcohólica 24 (10,5%) idiopática 16 (7%) otros factores 10 (4,4%). La mortalidad global fue de 29 pacientes (12,7%) que correspondieron a la etiología biliar 20 (11,2%) alcohólica idiopática 3 (18,7%). La mortalidad en las formas leves y moderadas fue 5% (T. 3) y en la severa 40,8% (T. 4). Los pacientes operados fueron clasificados en tres grupos de acuerdo al tiempo de realización del acto quirúrgico: 1) cirugía electiva; 2) cirugía precoz; 3) cirugía por complicaciones. No hubo mortalidad en los pacientes operados electivamente. En los operados en forma precoz fue de 18,75% (21 pacientes) mientras que los operados por complicaciones fue de 42,1% (8 pacientes) (T. 5). De acuerdo a la experiencia recogida consideramos que una vez diagnosticada una P. A. debe clasificarse con los índices conocidos, en formas leves y graves y simultáneamente debe estudiarse el factor causal presente. Las formas leves o moderadas son tratadas médicamente con el esquema clásico, manteniendo la vigilancia hasta su evolución clínica, momento en el cual, si se trata una P. A. biliar, pasa a cirugía electiva dentro de la misma internación. Las formas graves P.A.N. se tratan médicamente en Terapia Intensiva, por un equipo médico-quirúrgico si la evolución es satisfactoria, la conducta será similar a la anterior, si la evolución es desfavorable se deben poner en marcha todos los medios diagnósticos para demostrar la presencia de complicaciones que pueden exigir una cirugía de urgencia como las necrosis pancreáticas y peri-pancreáticas extensas y en especial la sepsis, que son los factores que desconpensan a éstos pacientes. La cirugía dentro de las primeras 48 horas, sólo la indicamos por duda diagnóstica u obstrucción biliar irreductible, especialmente, si coexiste con infección biliar: colangitis o colecistitis aguda

Pancreatitis aguda. Nuestra experiencia. / [Acute pancreatitis. Our experience]

Between the years 1975 and 1984, 228 patients with acute pancreatitis (A.P.) have been studied at the [quot ]A. Posadas Hospital[quot ]. The diagnosis was confirmed in 212 patients by surgery, in the remaining 16 by clinical evaluation, increase in the activity of serum or peritoneal fluid amylase, ultra-sonography and computed tomography. The sex distribution was: female 151 (66.2

) male 77 (33.8

), the mean age in each group was 42.9 and 45 years respectively. The etiologic factors were: biliary tract disease 178 (78

) alcohol 24 (10.5

) idiopathic 16 (7

) others factors 10 (4.4

). We found mild and moderate forms of the illness in 179 (78.5

) and severe form in 49 (21.5

) patients. The mortality rate of the whole group was 29 (12.7

) and according to the etiology it was, in the biliary group 20 (11.2

) alcoholic 4 (16.6

) idiopathic 3 (18.7

). The mortality in the mild and moderate forms was 5

and 40.8

in the severe forms. The patients who underwent surgery were classified in three groups according to the opportunity of surgical treatment: elective surgery, early surgery, surgery for complications. There was no mortality in the elective surgery group. The patients operated on early period had a mortality of 18.75

(21 pts.) whereas those operated due to complications had a mortality of 42.1

(8 pts.). According to the above mentioned experience we consider that a patient with an A.P. must be classified with the known indexes in mild or severe forms, at the same time one should study the actual etiologic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Valor de las pruebas de laboratorio y ecografía en el diagnóstico de la patología biliar en el período inicial de la pancreatitis aguda. / [Value of laboratory tests and echography in the diagnosis of biliary disease in the initial phase of acute pancreatitis]

The aim of this study was to investigate the usefulness of serum bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (APh) and real time ultrasonography (US) in distinguishing between gallstone and non gallstone related acute pancreatitis (A.P.). The second aim was to evaluate whether or nor there was biliary tract hypertension. Both aims were designed in order to evaluate them in the early stage of A.P. Two Groups of patients were studied. Group 1--gallstone related A.P., 63 pts. Group 2--Non gallstone related A.P. 21 pts. Fifty nine (93.6

) of Group 1 and 11 (52.3

) of Group 2 had surgical confirmation. In the other, the diagnosis was based on US and C.T. Blood samples were taken during the three days after admission for biochemical test and US was performed within the same period. Statistical evaluation and Students t test were used. Biochemical test: when the cut off level was expressed by the upper limit of normal (ULN), the highest diagnostic sensibility was (table 1): ALT 85.7

, APH 80.9

. AST 71

, bilirubin 65

. When the cut off level was chosen at twice the ULN (Table 1), the sensibility was: ALT 61.9

, bilirubin and AST 47

, APh 30

, Group 2 (Table 2) values higher than the ULN were: AST 42.8

, bilirubin 33

, ALT 19

, APh 14.2

. The differences between the two Groups were statistically significant: APh and bilirubin P less than 0.001, ALT less than 0.05 m AST, NS. Ultrasonography: Group 1: gallstones were detected in 96.6

(58/60). Biliary tree was not visualized in 10 (15.8

), diagnosed as normal in 38 (60.3

) and pathologic (dilatation and/or lithiasis) in 15 (23.8

).(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatitis crónica calcificada. Nuestra experiencia. / [Chronic calcified pancreatitis. Our experience]

Forty five cases of chronic pancreatitis have been diagnosed between January 1966 to July 1983 in the Hospital A. Posadas. The diagnosis was confirmed by the presence of one or more of the following data: pancreatic calcifications positive in 35, abnormal secretin test 37, ultrasonography and computed tomography pathological findings 10. Surgical operations were carried out in 25 patients and biopsy taken in 5. Thirty nine (86.6

) were males, 6 (13.3

) females, the mean age in each group was 47.4 and 39.8 years. Chronic alcoholism was certain in 41 (91.9) patients, in the remainder 4 no other etiologic factors were found. The main clinical data were: Weight loss 38 (84.4

) diabetes 34 (75.5

) pain 33 (73.3

in 7 as acute pancreatitis) Steatorrhea 23 (51.1

) jaundice 16 (35.5

- 11 by extrahepatic biliary tree obstruction, 5 by hepatic cirrhosis) pseudocysts 12 (26.6

). The more common associated diseases were: hepatic cirrhosis 6, fatty liver 2 (17.7

) gastroduodenal ulcer 6 (13.3

) cancer 4 (8.8

--gastric 1, pancreatic 3). In order to study the frequency of the clinical data the patients were grouped according to the presence or absence of calcifications and the etiologic factor Symptoms and signs were matched and statistic analysis (coefficient association phi) was made. Only a moderate association between acute pancreatitis in no calcified group and diabetes in calcified group were found. The chronologic study of certains clinical data shows that acute pancreatitis, jaundice, pseudo-cyst and surgical operations were significative more frequent in the first five years while diabetes has little more frequency in the second five year period. Twenty six surgical operations were carried out in 25 patients; 20 (76.9

) due to complications, 6 (23.1

) secondary to pain (pancreatic resection 3, pancreatoyeyunostomy 2, exploration 1). Twenty three patients were lost to follow-up, 12 died and 10 are still alive. This last group was followed at regular period, 8 remained asymptomatic and 2 have intermittent abdominal pain related to alcoholic ingestion.

Pancreatitis aguda: nuestra experiencia / Acute pancreatitis: our experience

Se estudiaron 228 pacientes con pancreatitis aguda internados en el Hospital Nacional Prof. A. Posadas, entre los años 1975-1984. El diagnóstico se confirmó en 212 por cirugía y en los restantes 16 por el cuadro clínico, elevación de amilasa en suero y líquido peritoneal; ecografía y tomografia computada. Pertenecieron al sexo femenino 151 (66,2%), al masculino 77 (33,8%) con edad promedio de 42,9 y 45 años respectivamente. La etiología fue: Patología biliar 178 (78%)alcohólica 24 (10,5%) idiopática 16 (7%) otros factores 10 (4,4%). La mortalidad global fue de 29 pacientes (12,7%) que correspondieron a la etiología biliar 20 (11,2%) alcohólica idiopática 3 (18,7%). La mortalidad en las formas leves y moderadas fue 5% (T. 3) y en la severa 40,8% (T. 4). Los pacientes operados fueron clasificados en tres grupos de acuerdo al tiempo de realización del acto quirúrgico: 1) cirugía electiva; 2) cirugía precoz; 3) cirugía por complicaciones. No hubo mortalidad en los pacientes operados electivamente. En los operados en forma precoz fue de 18,75% (21 pacientes) mientras que los operados por complicaciones fue de 42,1% (8 pacientes) (T. 5). De acuerdo a la experiencia recogida consideramos que una vez diagnosticada una P. A. debe clasificarse con los índices conocidos, en formas leves y graves y simultáneamente debe estudiarse el factor causal presente. Las formas leves o moderadas son tratadas médicamente con el esquema clásico, manteniendo la vigilancia hasta su evolución clínica, momento en el cual, si se trata una P. A. biliar, pasa a cirugía electiva dentro de la misma internación. Las formas graves P.A.N. se tratan médicamente en Terapia Intensiva, por un equipo médico-quirúrgico si la evolución es satisfactoria, la conducta será similar a la anterior, si la evolución es desfavorable se deben poner en marcha todos los medios diagnósticos para demostrar la presencia de complicaciones que pueden exigir una cirugía de urgencia como las necrosis pancreáticas y peri-pancreáticas extensas y en especial la sepsis, que son los factores que desconpensan a éstos pacientes. La cirugía dentro de las primeras 48 horas, sólo la indicamos por duda diagnóstica u obstrucción biliar irreductible, especialmente, si coexiste con infección biliar: colangitis o colecistitis aguda (AU)