Diseases (62)

Diagnostic Testing (35)

Note:

Note:

Rule out pancreatitis.


Note:

Rule out pancreatitis.


Note:

Rule out fatty liver, pancreatitis.


Note:

Note:

Rule out pancreatitis.


Note:

Rule out pancreatitis or pancreatic diseases.


Note:

Rule out acute pancreatitis.


Note:

Evaluate for pancreatitis


Note:

Rule out pancreatitis, or pancreatic cancer.


Note:

Rule out pancreatitis.


Note:

Rule out pancreatic diseases.


Note:

Rule out pancreatitits.


Note:

Rule out pancreatitis, or pancreatic cancer.


Note:

Rule out pancreatic disease.


Note:

Rule out pancreatitis.

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

LOINC

ICD10

A41Other sepsis
A41.02Sepsis due to Methicillin resistant Staphylococcus aureus
B26Mumps
B26.89Other mumps complications
B26.9Mumps without complication
C07Malignant neoplasm of parotid gland
C08Malignant neoplasm of other and unspecified major salivary glands
C08.0Malignant neoplasm of submandibular gland
C08.1Malignant neoplasm of sublingual gland
C08.9Malignant neoplasm of major salivary gland, unspecified
C16Malignant neoplasm of stomach
C16.0Malignant neoplasm of cardia
C16.1Malignant neoplasm of fundus of stomach
C16.2Malignant neoplasm of body of stomach
C16.3Malignant neoplasm of pyloric antrum
C16.4Malignant neoplasm of pylorus
C16.5Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6Malignant neoplasm of greater curvature of stomach, unspecified
C16.8Malignant neoplasm of overlapping sites of stomach
C16.9Malignant neoplasm of stomach, unspecified
C22Malignant neoplasm of liver and intrahepatic bile ducts
C22.0Liver cell carcinoma
C22.1Intrahepatic bile duct carcinoma
C22.8Malignant neoplasm of liver, primary, unspecified as to type
C22.9Malignant neoplasm of liver, not specified as primary or secondary
C23Malignant neoplasm of gallbladder
C24.0Malignant neoplasm of extrahepatic bile duct
C25Malignant neoplasm of pancreas
C25.0Malignant neoplasm of head of pancreas
C25.1Malignant neoplasm of body of pancreas
C25.2Malignant neoplasm of tail of pancreas
C25.7Malignant neoplasm of other parts of pancreas
C25.9Malignant neoplasm of pancreas, unspecified
D13Benign neoplasm of other and ill-defined parts of digestive system
D13.4Benign neoplasm of liver
D13.5Benign neoplasm of extrahepatic bile ducts
D13.6Benign neoplasm of pancreas
D69.0Allergic purpura
D69.2Other nonthrombocytopenic purpura
E44Protein-calorie malnutrition of moderate and mild degree
E44.0Moderate protein-calorie malnutrition
E44.1Mild protein-calorie malnutrition
E78Disorders of lipoprotein metabolism and other lipidemias
E78.1Pure hyperglyceridemia
E78.2Mixed hyperlipidemia
E78.6Lipoprotein deficiency
E78.9Disorder of lipoprotein metabolism, unspecified
E84Cystic fibrosis
E84.0Cystic fibrosis with pulmonary manifestations
E84.1Cystic fibrosis with intestinal manifestations
E84.11Meconium ileus in cystic fibrosis
E84.19Cystic fibrosis with other intestinal manifestations
E84.8Cystic fibrosis with other manifestations
E84.9Cystic fibrosis, unspecified
F10Alcohol related disorders
F10.1Alcohol abuse
F10.10Alcohol abuse, uncomplicated
F10.12Alcohol abuse with intoxication
F10.120Alcohol abuse with intoxication, uncomplicated
F10.150Alcohol abuse with alcohol-induced psychotic disorder with delusions
F10.2Alcohol dependence
F10.20Alcohol dependence, uncomplicated
F10.21Alcohol dependence, in remission
F10.9Alcohol use, unspecified
F55Abuse of non-psychoactive substances
G93.7Reye's syndrome
K11.2Sialoadenitis
K11.20Sialoadenitis, unspecified
K11.21Acute sialoadenitis
K11.22Acute recurrent sialoadenitis
K11.23Chronic sialoadenitis
K11.3Abscess of salivary gland
K25Gastric ulcer
K25.0Acute gastric ulcer with hemorrhage
K25.1Acute gastric ulcer with perforation
K25.2Acute gastric ulcer with both hemorrhage and perforation
K25.3Acute gastric ulcer without hemorrhage or perforation
K25.4Chronic or unspecified gastric ulcer with hemorrhage
K25.6Chronic or unspecified gastric ulcer with both hemorrhage and perforation
K25.7Chronic gastric ulcer without hemorrhage or perforation
K26Duodenal ulcer
K27Peptic ulcer, site unspecified
K27.7Chronic peptic ulcer, site unspecified, without hemorrhage or perforation
K35Acute appendicitis
K35.2Acute appendicitis with generalized peritonitis
K35.3Acute appendicitis with localized peritonitis
K35.80Unspecified acute appendicitis
K35.89Other acute appendicitis
K52Other and unspecified noninfective gastroenteritis and colitis
K57Diverticular disease of intestine
K57.20Diverticulitis of large intestine with perforation and abscess without bleeding
K57.32Diverticulitis of large intestine without perforation or abscess without bleeding
K57.40Diverticulitis of both small and large intestine with perforation and abscess without bleeding
K57.52Diverticulitis of both small and large intestine without perforation or abscess without bleeding
K57.80Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding
K57.92Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
K65Peritonitis
K65.1Peritoneal abscess
K65.8Other peritonitis
K65.9Peritonitis, unspecified
K67Disorders of peritoneum in infectious diseases classified elsewhere
K70Alcoholic liver disease
K70.0Alcoholic fatty liver
K70.1Alcoholic hepatitis
K70.10Alcoholic hepatitis without ascites
K70.11Alcoholic hepatitis with ascites
K70.9Alcoholic liver disease, unspecified
K71Toxic liver disease
K71.3Toxic liver disease with chronic persistent hepatitis
K71.9Toxic liver disease, unspecified
K72Hepatic failure, not elsewhere classified
K72.0Acute and subacute hepatic failure
K72.00Acute and subacute hepatic failure without coma
K72.01Acute and subacute hepatic failure with coma
K72.11Chronic hepatic failure with coma
K72.90Hepatic failure, unspecified without coma
K72.91Hepatic failure, unspecified with coma
K74.69Other cirrhosis of liver
K75Other inflammatory liver diseases
K75.0Abscess of liver
K76Other diseases of liver
K76.0Fatty (change of) liver, not elsewhere classified
K76.3Infarction of liver
K76.89Other specified diseases of liver
K76.9Liver disease, unspecified
K77Liver disorders in diseases classified elsewhere
K80Cholelithiasis
K80.0Calculus of gallbladder with acute cholecystitis
K80.1Calculus of gallbladder with other cholecystitis
K81Cholecystitis
K81.0Acute cholecystitis
K81.1Chronic cholecystitis
K81.2Acute cholecystitis with chronic cholecystitis
K81.9Cholecystitis, unspecified
K83Other diseases of biliary tract
K83.0Cholangitis
K83.1Obstruction of bile duct
K83.9Disease of biliary tract, unspecified
K85Acute pancreatitis
K85.0Idiopathic acute pancreatitis
K85.1Biliary acute pancreatitis
K85.2Alcohol induced acute pancreatitis
K85.3Drug induced acute pancreatitis
K85.8Other acute pancreatitis
K85.9Acute pancreatitis, unspecified
K86Other diseases of pancreas
K86.0Alcohol-induced chronic pancreatitis
K86.1Other chronic pancreatitis
K86.2Cyst of pancreas
K86.3Pseudocyst of pancreas
K86.8Other specified diseases of pancreas
K86.9Disease of pancreas, unspecified
K90Intestinal malabsorption
K90.89Other intestinal malabsorption
K90.9Intestinal malabsorption, unspecified
M25.48Effusion, other site
M36.4Arthropathy in hypersensitivity reactions classified elsewhere
P36.30Sepsis of newborn due to unspecified staphylococci
P58Neonatal jaundice due to other excessive hemolysis
P59.0Neonatal jaundice associated with preterm delivery
P59.9Neonatal jaundice, unspecified
R10Abdominal and pelvic pain
R10.0Acute abdomen
R10.10Upper abdominal pain, unspecified
R10.30Lower abdominal pain, unspecified
R10.8Other abdominal pain
R10.84Generalized abdominal pain
R10.9Unspecified abdominal pain
R17Unspecified jaundice
R18Ascites
R18.8Other ascites
R19Other symptoms and signs involving the digestive system and abdomen
R65.1Systemic inflammatory response syndrome (SIRS) of non-infectious origin
R65.11Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction
R65.2Severe sepsis
R74.0Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]
R78.0Finding of alcohol in blood
R94Abnormal results of function studies
R94.5Abnormal results of liver function studies
T39.1Poisoning by, adverse effect of and underdosing of 4-Aminophenol derivatives
T39.1X1Poisoning by 4-Aminophenol derivatives, accidental (unintentional)
T39.1X2Poisoning by 4-Aminophenol derivatives, intentional self-harm
T39.1X3Poisoning by 4-Aminophenol derivatives, assault
T39.1X4Poisoning by 4-Aminophenol derivatives, undetermined
Z02.83Encounter for blood-alcohol and blood-drug test
Z13.71Encounter for nonprocreative screening for genetic disease carrier status
Z14.1Cystic fibrosis carrier
Z31.430Encounter of female for testing for genetic disease carrier status for procreative management
Z31.440Encounter of male for testing for genetic disease carrier status for procreative management
Z71.4Alcohol abuse counseling and surveillance
Z81.1Family history of alcohol abuse and dependence
Z81.2Family history of tobacco abuse and dependence
Z84.81Family history of carrier of genetic disease
Z85Personal history of malignant neoplasm
Z85.028Personal history of other malignant neoplasm of stomach
Z85.05Personal history of malignant neoplasm of liver
Z85.07Personal history of malignant neoplasm of pancreas
Z85.09Personal history of malignant neoplasm of other digestive organs

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