Normal Duration of Acute

[Guest guest]

Is this normal???

One morning, I woke up with abdomen pain with no nausea. I went to

the emergency room and they diagnosed me with acute pancreatitis.

(high level of amaylase-600) I had pain the next day. (only 2 days of

pain) The following day my levels were normal and I had no pain.

Is there a possibility that I was misdiagnosed?

[Guest guest]

Dear ,

Yes there is a good chance that your were

misdiagnosed...basically because your pain issues resolved so

fast and because the ED didn't do any confirmatory imaging

tests to lend support to the diagnosis of AP(?). I just read a good

article yesterday describing exactly the situation that you are

describing. But, that being said, there are known cases of full

blown AP with little or no pain....so although severe pain is the

hallmark of the attack, it is not always present. So, you can not

completely rule it out either....... (how's that for being

wishy-washy?)

One good reason that you may have been misdiagnosed

revolves around the blood test that they did. Amylase is produced

in many areas of the body other than the pancreas and higher

levels can be caused by problems not arising from the

pancreas. For example, injury or problems from your salivary

glands, or stomach problems, or liver disorders, or even certain

medicines can elevate amlyase blood concentrations. In

addition, the assay that is used to detect the enzyme can cause

mis-diagnoses. According to this review article " a minimum of

serum amylase three times the upper limits of normal is 'almost

always diagnostic of pancreatitis' " . So, if your elevation was less

than three times the upper limit of normal, there is a chance that

you did not have pancreatitis. Some investigators believe that

you need to be more than 5 times the upper limit to diagnose AP.

Basically, my understanding is that it is not the best practice to

diagnose AP based solely on the amylase value.....that CT films,

other blood tests and a good physical exam and history taking

are all needed to arrive at a good diagnosis.

Laurie

(oh as far as returning to normal so quickly: " After reaching a

peak, the return of serum amylase to previously normal levels

does not necessarily correlate to resolution of the clinical

illness. " Amylase has a short half life and levels fall quickly and

can return to normal within 5-7 days of the attack. " In acute

disease, serum amylase levels usually rise within 6-24 hours,

peak at 48 hours and normalize over the next 5-7 days. " This is

true even if the inflammation persists. " The central clinical

question that remains poorly defined is whether amylase level

alone can be used to confirm or refute a diagnosis of acute

pancreatitis. "

Information quoted from " Amylase and Lipase in the Emergency

Department Evaluation of Acute Pancreatitis. " Vissers, RJ et al

in The Journal of Emergency Medicine. 1999.