All of the following are associated with raised serum amylase, except: (AIIMS Nov 2011)
|A||Bleeding peptic ulcer|
|B||Perforation of gut|
a. The overall sensitivity and specificity of serum amylase determination in the diagnosis of pancreatitis depend on both the clinical presentation and the cutoff value chosen for the upper limit of normal.
b. Hyperamylasemia can be associated with acute cholecystitis, perforated viscus, bowel obstruction, and bowel infarction.
c. These states can also be clinically confused with pancreatitis because they are also characterized by abdominal pain, nausea, vomiting, and ab-dominal tenderness.
d. In most cases, patients with hyperamylasemia that is not due to pancreatitis have only mild elevations in the circulating amylase level (i.e., twofold to threefold elevations from the normal value), whereas those with pancreatitis usually have greater elevations.
e. In some patients with hyperlipidemia-induced pancreatitis, hyperamylasemia may be masked by circulating amylase inhibitors.
f. Macroamylasemia is a form of pancreatitis-independent hyperamylasemia that affects 0.5% of individuals. It occurs when amylase binds to an abnormal circulating albumin-like protein.