Amylase, Serum
Medical Test

Diseases (66)
Screening/Initial Testing (11)
Diagnostic Testing (38)
Peritonitis
10
Note:
Obstruction of bile duct
9
Note:

Rule out pancreatitis.

Acute appendicitis
8
Note:

Rule out pancreatitis.

Acute hepatic failure
8
Note:

Rule out fatty liver, pancreatitis.

Jaundice
8
Note:
Peritoneal effusion
8
Note:

Rule out pancreatitis.

Acute gastric ulcer
7
Note:

Rule out pancreatitis or pancreatic diseases.

Diverticulitis of colon
7
Note:

Rule out acute pancreatitis.

Familial hypobetalipoproteinemia
7
Note:

Evaluate for pancreatitis

Malignant neoplasm, stomach
7
Note:

Rule out pancreatitis, or pancreatic cancer.

Acetaminophen overdose
6
Note:

Rule out pancreatitis.

Chronic gastric ulcer
6
Note:

Rule out pancreatic diseases.

Inherited bone marrow failure syndromes
6
Note:

Decreased in Shwachman-Diamond Syndrome.

Peptic ulcer disease
6
Note:

Rule out pancreatitits.

Adenocarcinoma of stomach (Gastric adenocarcinoma)
5
Note:

Rule out pancreatitis, or pancreatic cancer.

Alcohol abuse
5
Note:

Rule out pancreatic disease.

Chronic liver disease
4
Note:

Rule out pancreatitis.

Disease Management Testing (17)

Overview

The enzyme amylase originates in either the pancreas or salivary glands and aids the body’s digestive process. Pancreatic amylase is secreted through the pancreatic duct into the duodenum and its primary function is to break down fats, proteins and carbohydrates as a first step in the digestion process. Amylase produced by the salivary glands helps convert starches into complex sugars such as dextrose. Other tissues may also exhibit some amylase activity, including the ovaries, fallopian tubes, small and large intestine, liver, placenta and skeletal muscle. Amylase enzyme levels increase when these glands are inflamed or obstructed.

Amylase is usually present in the blood and urine in small quantities. Levels have been shown to increase in blood and urine after pancreatic cell injury (pancreatitis), in pancreatic duct obstructions (gallstones, or rarely with obstruction by pancreatic tumor) and in some genetic disorders that affect pancreatic function such as cystic fibrosis.

The primary use of total serum amylase is in the diagnosis of acute pancreatitis. In this disorder, serum amylase begins to rise within 2 to 12 hours of onset of symptoms, with peak levels occurring in 12 to 72 hours, and levels returning to normal usually within 4 days. Elevations of 4 to 6 times normal are usual, but some patients show lesser elevation and a few show no elevation. Serum amylase levels do not correlate with the severity of illness and a return to normal is not always an indicator of resolution of illness. In patients with hyperlipidemia the amylase levels may be normal; this can be approached by ultracentrifugation of the specimen or serial dilutions. Amylase is not specific to the pancreas or pancreatitis. Elevated levels can be seen in diseases such as ectopic pregnancy, intestinal diseases, salivary gland disease and mumps.

Clinical Utility
  • In diagnosis of pancreatitis
  • In diagnosis of pancreatic obstructive disease
  • In diagnosis of pancreatic cancer (carcinoma)
  • Evaluation of pancreatic function
  • Aid in diagnosis of cystic fibrosis

Interpretation

Increased in:

  • Acute pancreatitis
  • Obstructive pancreatic disease (cholecystitis, choledocholithiasis, stricture, duct sphincter spasm)
  • Pancreatic carcinoma
  • Pancreatic cyst and pseudocyst
  • Bowel obstruction, infarction or perforation
  • Intraabdominal inflammation/ acute abdomen
  • Mumps
  • Parotitis
  • Diabetic ketoacidosis
  • Infected salivary glands
  • Macroamylasemia
  • Renal failure
  • Also slightly elevated in ruptured ectopic pregnancy and macroamylasemia
  • Some drugs can increase levels of amylase, such as azathioprine, alcohol, oral contraceptives, ibuprofen, sulfonamides, furosemide, captopril, corticosteriods and hydrochlorothiazide.

Note: The magnitude of the elevation of serum amylase activity is not related to the severity of pancreatic involvement; however, the greater the rise, the greater the probability of acute pancreatitis.

Decreased in:

  • Pancreatic insufficiency
  • Cystic fibrosis
  • Severe liver disease
  • Pancreatectomy
  • Usually normal or low in chronic pancreatitis

Reference Ranges

Serum Ranges:
Adult 20–104 U/L (0.34–1.77 ukat/L)

Urine Ranges:
Adult <= 650 U/L (<= 10.9 ukat/L)

Methodology

Enzymatic/chemiluminescent

Specimen Collection

Serum (SST) , Urine (Random or 24 hour), Body Fluid

  • Ambient - 7 days
  • Refrigerated - 7 days
  • Frozen - 30 days

Additional Testing

Lipase, Amylase Isoenzymes, Bilirubin Direct and Total, Comprehensive Metabolic Panel, Bile Fluid Examination, Calcium Serum, C-reactive protein, Urine amylase.

Turnaround Time

Usually 1 day after receipt in performing laboratory.

CPT
82150$6.48$6.48

ICD10
ICD CODE AND DESCRIPTIONLCD CODENCD CODE
A41 - Other sepsis——
A41.02 - Sepsis due to Methicillin resistant Staphylococcus aureus——
A49.02 - Methicillin resistant Staphylococcus aureus infection, unspecified site——
B26 - Mumps——
B26.89 - Other mumps complications——
B26.9 - Mumps without complication——
B95.62 - Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere——
C07 - Malignant neoplasm of parotid gland——
C08 - Malignant neoplasm of other and unspecified major salivary glands——
C08.0 - Malignant neoplasm of submandibular gland——
C08.1 - Malignant neoplasm of sublingual gland——
C08.9 - Malignant neoplasm of major salivary gland, unspecified——
C16 - Malignant neoplasm of stomach——
C16.0 - Malignant neoplasm of cardia——
C16.1 - Malignant neoplasm of fundus of stomach——
C16.2 - Malignant neoplasm of body of stomach——
C16.3 - Malignant neoplasm of pyloric antrum——
C16.4 - Malignant neoplasm of pylorus——
C16.5 - Malignant neoplasm of lesser curvature of stomach, unspecified——
C16.6 - Malignant neoplasm of greater curvature of stomach, unspecified——
C16.8 - Malignant neoplasm of overlapping sites of stomach——
C16.9 - Malignant neoplasm of stomach, unspecified——
C17 - Malignant neoplasm of small intestine——
C17.9 - Malignant neoplasm of small intestine, unspecified——
C22 - Malignant neoplasm of liver and intrahepatic bile ducts——
C22.0 - Liver cell carcinoma——
C22.1 - Intrahepatic bile duct carcinoma——
C22.7 - Other specified carcinomas of liver——
C22.8 - Malignant neoplasm of liver, primary, unspecified as to type——
C22.9 - Malignant neoplasm of liver, not specified as primary or secondary——
C23 - Malignant neoplasm of gallbladder——
C24 - Malignant neoplasm of other and unspecified parts of biliary tract——
C24.0 - Malignant neoplasm of extrahepatic bile duct——
C25 - Malignant neoplasm of pancreas——
C25.0 - Malignant neoplasm of head of pancreas——
C25.1 - Malignant neoplasm of body of pancreas——
C25.2 - Malignant neoplasm of tail of pancreas——
C25.3 - Malignant neoplasm of pancreatic duct——
C25.4 - Malignant neoplasm of endocrine pancreas——
C25.7 - Malignant neoplasm of other parts of pancreas——
C25.8 - Malignant neoplasm of overlapping sites of pancreas——
C25.9 - Malignant neoplasm of pancreas, unspecified——
C26 - Malignant neoplasm of other and ill-defined digestive organs——
C26.9 - Malignant neoplasm of ill-defined sites within the digestive system——
C49.A2 - Gastrointestinal stromal tumor of stomach——
C78.7 - Secondary malignant neoplasm of liver and intrahepatic bile duct——
C7A.092 - Malignant carcinoid tumor of the stomach——
D00 - Carcinoma in situ of oral cavity, esophagus and stomach——
D00.2 - Carcinoma in situ of stomach——
D01.5 - Carcinoma in situ of liver, gallbladder and bile ducts——

Additional ICD10
ICD CODE AND DESCRIPTIONLCD CODENCD CODE
A06.4 - Amebic liver abscess——
A41.0 - Sepsis due to Staphylococcus aureus——
A41.01 - Sepsis due to Methicillin susceptible Staphylococcus aureus——
A41.02 - Sepsis due to Methicillin resistant Staphylococcus aureus——
A41.1 - Sepsis due to other specified staphylococcus——
A41.2 - Sepsis due to unspecified staphylococcus——
A41.3 - Sepsis due to Hemophilus influenzae——
A41.4 - Sepsis due to anaerobes——
A41.5 - Sepsis due to other Gram-negative organisms——
A41.50 - Gram-negative sepsis, unspecified——
A41.51 - Sepsis due to Escherichia coli [E. coli]——
A41.52 - Sepsis due to Pseudomonas——
A41.53 - Sepsis due to Serratia——
A41.59 - Other Gram-negative sepsis——
A41.8 - Other specified sepsis——
A41.81 - Sepsis due to Enterococcus——
A41.89 - Other specified sepsis——
A41.9 - Sepsis, unspecified organism——
A49.02 - Methicillin resistant Staphylococcus aureus infection, unspecified site——
B18.0 - Chronic viral hepatitis B with delta-agent——
B18.1 - Chronic viral hepatitis B without delta-agent——
B18.2 - Chronic viral hepatitis C——
B19.0 - Unspecified viral hepatitis with hepatic coma——
B19.1 - Unspecified viral hepatitis B——
B19.10 - Unspecified viral hepatitis B without hepatic coma——
B19.11 - Unspecified viral hepatitis B with hepatic coma——
B19.2 - Unspecified viral hepatitis C——
B19.20 - Unspecified viral hepatitis C without hepatic coma——
B19.21 - Unspecified viral hepatitis C with hepatic coma——
B19.9 - Unspecified viral hepatitis without hepatic coma——
B25.2 - Cytomegaloviral pancreatitis——
B26.0 - Mumps orchitis——
B26.1 - Mumps meningitis——
B26.2 - Mumps encephalitis——
B26.3 - Mumps pancreatitis——
B26.8 - Mumps with other complications——
B26.81 - Mumps hepatitis——
B26.82 - Mumps myocarditis——
B26.83 - Mumps nephritis——
B26.84 - Mumps polyneuropathy——
B26.85 - Mumps arthritis——
B26.89 - Other mumps complications——
B26.9 - Mumps without complication——
B95.62 - Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere——
C08.0 - Malignant neoplasm of submandibular gland——
C08.1 - Malignant neoplasm of sublingual gland——
C08.9 - Malignant neoplasm of major salivary gland, unspecified——
C16.0 - Malignant neoplasm of cardia——
C16.1 - Malignant neoplasm of fundus of stomach——
C16.2 - Malignant neoplasm of body of stomach——

References
  • J Clin Pathol. 2006 Apr;59(4):340-4. [PMID:16567468]
  • J Clin Gastroenterol. 2002;34:459. [PMID:11907364]
  • Clin Chim Acta. 2005;362:26. [PMID:16024009]
  • Alan Wu. Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders; 4 edition (June 13, 2006). ISBN-10: 0721679757