The amylase creatinine clearance ratio

Murray, William R (1981) The amylase creatinine clearance ratio. MD thesis, University of Glasgow.

Abstract

The aims of the studies in this thesis were to evaluate the role of the amylase creatinine clearance ratio (ACCR) as a diagnostic test in British patients with acute pancreatitis and to attempt to demonstrate whether or not a significant elevation in the ACCR is related to pancreatic inflammation. In two studies in this thesis a significant elevation in the ACCR was found to be 94% accurate in diagnosing acute pancreatitis confirmed by other methods and the ACCR was found to be the most successful single-non- invasive diagnostic test for this condition. No patient without acute pancreatitis was found to have an ACCR above the upper limit of normal, including patients with acute abdominal conditions other than acute pancreatitis who had hyperamylasaemia. The ACCR was also found to have prognostic significance in acute pancreatitis being significantly related to the severity of each attack as defined by established prognostic factors and retrospective analysis of each patient*s illness. An admission ACCR of over 10% in a patient with acute pancreatitis was found to be highly suggestive of a severe attack with a mortality greater than 50%. The ACCR was found to remain abnormal for longer than serum amylase in acute pancreatitis and was judged to be of value in diagnosing acute pancreatitis in patients presenting to hospital with abdominal pain of over 48 hours duration, Post-cholecystectomy pancreatitis is well documented and significant ACCR elevations have been recorded after biliary surgery. A study was designed to confirm significant ACCR elevations after biliary surgery and demonstrate that this elevation was related to pancreatic inflammation. Intravenous Trasylol, a proteolytic enzyme inhibitor, was infused before, during and after biliary surgery in a group of patients and was found to significantly reduce the incidence of significant ACCR elevation on the first postoperative day. It has been shown in animal experiments that Trasylol can significantly modify the severity of acute pancreatitis when given prior to the induction of the pancreatitis and its failure to significantly influence the course of established acute pancreatitis in humans is almost certainly due to the fact that it is given once the inflammatory process is established. In this study it was possible to administer Trasylol prophylactically with results in keeping with the hypothesis that post- biliary surgery ACCR elevation is due to pancreatic inflammation. Acute pancreatitis and elevated ACCR values have also been recorded after cardiac surgery performed using non-pulsatile cardiopulmonary bypass. The pancreatitis developing in this situation is thought to be ischaemic in origin and it has recently been shown that pulsatile cardiopulmonary bypass can improve tissue perfusion and the functioning of several organs during bypass, ACCR changes during and after cardiac surgery performed using either non-pulsatile bypass or pulsatile bypass were studied. Significant ACCR elevation was observed in 9 out of 10 patients using non-pulsatile bypass but only 1 out of 10 patients using pulsatile bypass. The AGCR changes associated with cardiac surgery performed using cardiopulmonary bypass can therefore be significantly altered by the mode of perfusion employed. The evidence from this study suggests that the significant reduction in ACCR elevation during and after pulsatile bypass is related to normalisation of pancreatic function resulting from improved tissue perfusion. (Abstract shortened by ProQuest.).

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Additional Information: Adviser: Andrew Watt Kay
• Keywords: Medicine
• Date of Award: 1981
• Depositing User: Enlighten Team
• Unique ID: glathesis:1981-71976
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 24 May 2019 15:11
• Last Modified: 24 May 2019 15:11
• URI: https://theses.gla.ac.uk/id/eprint/71976