Hyperamylasemia

Background

• Amylase is secreted by the pancreas into the duodenum where it aids the catabolism of carbohydrates to simple sugars
• Damage to the pancreas or obstruction to the pancreatic duct causes the enzyme to enter the bloodstream.

Clinical Features

• Pain in the middle of the chest that radiates to the back
• Fever
• Loss of appetite
• Nausea
• Vomiting
• Sweating
• Weakness
• Jaundice
• Rapid pulse
• Steatorrhea

Differential Diagnosis

• Pancreatic:
• * Acute pancreatitis
• *
• * Chronic pancreatitis (can have normal or mildly elevated levels)
• *
• * Pancreatic pseudocyst
• *
• * Pancreatic duct obstruction
• *
• * Pancreatic trauma or neoplasm
• *
• Non-Pancreatic:
• * Salivary gland disease (e.g., parotitis)
• *
• * Perforated peptic ulcer
• *
• * Bowel obstruction or infarction
• *
• * Cholecystitis
• *
• * Ectopic pregnancy
• *
• * Ruptured aortic aneurysm
• *
• * Macroamylasemia
• *
• * Renal failure (impaired clearance)

Evaluation

Diagnosis

• Amylase level >100 U/dl