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Sample

  1. This test is done in the serum of the patient.
  2. The serum is stable at room temp. for 7 days and at 4 °C for one month.
  3. Take 3 to 5 ml of blood in the disposable syringe. Keep the syringe for 15 to 30 minutes and then centrifuge for 2 to 4 minutes. In this way can get clear serum.

Precautions

  1. Avoid alcohol intake before sampling because it gives rise to an increase in the amylase level.
  2. Urine can be collected at 2 hours or 24 hours sample. Refrigerate the urine.
  3. Avoid contamination with saliva.
  4. Lipemia, anticoagulant EDTA, fluoride, and citrate decreased amylase level.

Purpose of the test

  1. To diagnose acute pancreatitis and monitor the treatment.
  2. To differentiate other abdominal pain, epigastric discomfort, nausea, and vomiting.
  3. In the case of ascites, may be done to rule out pancreatitis.

Pathophysiology

  1. Amylase is the smallest enzyme with a molecular weight of 50,000 to 55,000.
    1. Because of small size, it is filtered through the glomeruli and appear in the urine.
  2. This enzyme is synthesized in the pancreas and salivary gland. Amylase is secreted into the gastrointestinal tract, where it helps to digest starch and glycogen in the mouth, stomach, and intestine.
    1. Serum amylase consists of:
      1. Salivary gland amylase is  S-type.
      2. Pancreatic amylase is P-type.

  1. Amylase is normally secreted from the pancreatic acinar cells into the pancreatic duct and then into the duodenum.
  2. Once in the intestine, it helps in the catabolism of carbohydrate and starch to simple sugars.

  1. Amylase activity is low in the infant blood for the first 2 months of life and reaches adult level by the age of one year.
  2. Amylase high activity is seen in Pancreas and parotid gland.
  3. In the case of acute pancreatitis:
        1. It increases in the first 3-6 hours (another reference 2 to 12 hours).
        2. The maximum level in 20 – 30 hours ( another reference 12 to 72 hours).
        3. Fall to normal within 48 to 72 hours (3 to 5 days).
        4. It may increase up to 40 times normal, the level may vary from 250 to 1000 Somogyi units/dL.
          1. The level may go much higher than the above value.
        5. In case of persistent level more than 5 days, suggests a complication like a pseudocyst.

  1. Once there is damage to pancreatic acinar cells then amylase out pours into the peritoneum and absorbed by the blood and lymph.
  2. Amylase exists in two isoenzyme forms:
    1. P - amylase is 40% of the total and found in the pancreas.
    2. S - amylase is 60% of the total and found in the salivary glands, ovary, fallopian tubes, bronchial epithelium, testes, and intestine.
  3. α-Amylase found in the humans.
    1. β-Amylase found in the bacteria and plants.

Normal

The value may vary from lab to lab.

      • Adult = 30 to 220 U/L.
      • Newborn = 6 to 65 U /L

Another source:

      • Newborn   =  5 to 65 U/L
      • Adult        =  27 to 131 U/L
      • Adult 60 to 90 years  = 24 to 151 U/L

Source 2

      • Serum
        • Adult = 60 to 120 Somogyi unit/dL
        • Values may increase during pregnancy.
        • Values may increase in old people.
      • Urine 24 hours 
        • Up to 5000 Somogyi units/24 hours

Another source:

Critical values

      • More than three times the upper limit of the normal.

Acute Pancreatitis

        1. Rise starts in  2 to 12 hours.
        2. Peak level reaches in 12 to 72 hours.
        3. Normal level reaches in  3 to 4 days.
          1. 10% of the cases of acute pancreatitis are associated with a normal level of amylase.
          2. Sensitivity is lowest in chronic relapsing and alcoholic pancreatitis.
          3. 30% of the cases are due to non-pancreatic causes like:
            1. Diabetic ketoacidosis.
            2. Acute cholecystitis.
            3. Peptic ulcers.
            4. Salpingitis.
            5. Ectopic pregnancy.
            6. Intestinal ischemia.
            7. Intestinal obstruction.
            8. Renal insufficiency.
            9. Macromylasemia.
        4. For diagnosis of acute pancreatitis:
          1. Amylase  is 3 times normal with a specificity of 95% and sensitivity of 60 to 80%
          2. Lipase is also 3 times the normal with specificity and sensitivity of 90% each.

Amylase increased level is seen in:

      1. Acute Pancreatitis and Acute exacerbation of chronic Pancreatitis.
      2. Pancreatic cyst and pseudocyst.
      3. Acute alcoholic poisoning.
      4. Salivary glands diseases like mumps, or duct obstruction or parotitis.
      5. Maybe in acute cholecystitis, intestinal obstructions.
      6. Increased in obstruction of common bile duct, pancreatic duct, or ampulla of Vater.
      7. Ruptured Ectopic pregnancy.
      8. Renal failure due to reduced excretion by the kidneys.
      9. Diabetic ketoacidosis.
      10. In peritonitis.
      11. In some of the lung and o to 65 ovarian tumors.
      12. Alcohol intake.
      13. May be seen in abdominal trauma, head injury, viral infections, and postoperative patient.

Amylase level Decreased in:

    1. Extensive marked destruction of pancreas e.g. Acute Fulminant Pancreatitis.
    2. Chronic Pancreatitis and pancreatic cancer.
    3. In pancreatectomy.
    4. Cirrhosis and severe liver diseases like hepatitis.
    5. Perforating or penetrating peptic ulcer.
    6. Toxemia of pregnancy.
    7. Advanced cystic fibrosis.

Important facts


Possible References Used

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