CONTROL: 60 patients without abdominal diseases. b)
Acute pancreatitis: 60 patients, the diagnosis was made according to clinical symptoms, biochemical tests, U.S. and C.T. in 24 (40%), in the remainder 36 (60%) surgical confirmation was obtained. c) Acute
biliary tract disease without macroscopic pancreatic damage, 30 patients, the diagnosis was made according to biochemical tests and U.S. in 4 (13.3%) whereas in the remainder 26 (86.6%) surgical confirmation was accomplished no later than a week of the beginning of the symptoms. Biochemical tests: serum and urine
amylase,
lipase, and total pancreatic and salivary isoamylases were evaluated. In the group of
acute pancreatitis the highest diagnostic sensibility was: pancreatic
isoamylase 95.5%,
lipase 95%, total serum
amylase 93.3% urine
amylase 90%, serum
amylase 78.3%. In acute
biliary tract diseases a high number of elevated
enzyme values were also found: pancreatic
isoamylase 83.3%, total
isoamylase 73.3%, urine
amylase 66.6%,
lipase 63.3%, serum
amylase 53.3%. The mean
enzyme values of both groups were compared statistically and showed no significant difference. We conclude that
lipase and isoamylases are the best markers for the diagnosis of
acute pancreatitis and the differential diagnosis with acute biliary diseases is difficult because an elevation of these
enzymes is a characteristic shared by both pathologies. The diagnosis of
acute pancreatitis based only in clinical symptoms and
hyperamylasemia can be erroneous.