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Amylase Enzymatic Ascitic Fluid

Pancreas
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Report in 48Hrs

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At Home

nofastingrequire

No Fasting Required

Details

Measures amylase levels in ascitic fluid.

₹666₹951

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Amylase Enzymatic Ascitic Fluid - Comprehensive Medical Test Guide

  • Why is it done?
    • Measures the level of amylase enzyme present in ascitic fluid (fluid accumulated in the abdominal cavity) to help diagnose the cause of ascites
    • Evaluates for acute pancreatitis complications, including pancreatic rupture, fistula formation, or leakage into the peritoneal cavity
    • Differentiates between various causes of ascites such as peritonitis, malignancy, cirrhosis, and pancreatic disease
    • Assists in diagnosing pancreatic pseudocysts that may communicate with the peritoneal cavity
    • Typically ordered during diagnostic paracentesis (abdominal fluid aspiration) when ascites etiology is unclear or pancreatitis-related complications are suspected
    • May be performed as part of routine ascitic fluid analysis in patients with new or unexplained ascites
  • Normal Range
    • Normal/Reference Range: 0-1 unit/L (IU/L) or up to 1 Somogyi unit/L in ascitic fluid
    • Elevated Amylase Ascitic Fluid: > 1 IU/L, typically significantly elevated (10-100+ times normal serum values) when abnormal
    • Units of Measurement: International Units per Liter (IU/L) or Somogyi units/mL (S/mL)
    • Interpretation: Normal amylase in ascitic fluid is expected and reflects minimal enzyme present in peritoneal fluid at baseline. Elevated levels indicate pancreatic enzyme leakage into the peritoneal cavity, suggesting pancreatic pathology, rupture, or pseudocyst communication with the abdomen.
    • Clinical Significance: A ratio of ascitic amylase to serum amylase > 1.0 is highly specific for pancreatic origin, while a ratio < 1.0 suggests non-pancreatic causes of elevated amylase
  • Interpretation
    • Low/Normal Amylase (0-1 IU/L): Indicates no pancreatic enzyme leakage; rules out pancreatic rupture or pseudocyst communication; consistent with ascites from liver cirrhosis, malignancy, kidney disease, or cardiac causes
    • Mildly Elevated Amylase (2-3 times normal): May suggest minor pancreatic inflammation or partial enzymatic leakage; requires correlation with clinical presentation and serum amylase levels
    • Significantly Elevated Amylase (> 10x serum amylase): Strongly suggests acute pancreatitis with complications, pancreatic rupture, pancreatic pseudocyst fistula, or pancreatic abscess communicating with peritoneal cavity
    • Ascites/Serum Amylase Ratio Interpretation: Ratio > 1.0 = Pancreatic source; Ratio < 1.0 = Non-pancreatic source (salivary amylase, liver disease, renal failure); Ratio = 1.0 = Ambiguous, requires additional investigation
    • Factors Affecting Results: Time since pancreatic injury (elevated immediately); Contamination with blood (may increase values); Specimen handling and timing; Presence of malignancy or infections affecting enzyme levels; Salivary amylase can elevate total amylase without indicating pancreatic disease
    • Clinical Patterns: Progressive elevation with repeated taps suggests ongoing pancreatic leakage; Persistent elevation indicates unresolved pancreatic pathology; Declining levels may suggest healing or pseudocyst closure
  • Associated Organs
    • Primary Organs Involved: Pancreas (primary source of amylase enzyme); Peritoneal cavity/peritoneum (fluid collection site); Gastrointestinal tract (secondary involvement in pancreatitis); Liver (ascites formation in cirrhosis)
    • Conditions Associated with Elevated Amylase in Ascitic Fluid:
    • Acute pancreatitis with complications
    • Chronic pancreatitis with pseudocyst formation
    • Pancreatic rupture or perforation
    • Pancreatic pseudocyst with peritoneal communication or rupture
    • Pancreatic abscess
    • Traumatic injury to pancreas
    • Post-surgical pancreatic fistula
    • Pancreatic cancer with peritoneal involvement
    • Diseases Helped by This Test: Differentiates pancreatic from non-pancreatic causes of ascites (cirrhosis, malignancy, peritonitis, heart failure, nephrotic syndrome); Identifies pancreatic complications in acute/chronic pancreatitis; Detects pseudocyst rupture or fistula; Guides treatment decisions regarding surgical intervention
    • Potential Complications Associated with Abnormal Results: Sepsis and peritonitis from pancreatic rupture; Organ failure from severe pancreatitis; Hemorrhage from erosion into blood vessels; Bowel perforation; Infection of pseudocyst; Malnutrition from pancreatic insufficiency; Chronic pancreatitis with risk of malignancy
  • Follow-up Tests
    • Recommended Follow-up Tests for Elevated Ascitic Amylase:
    • Serum amylase and lipase levels (to calculate ascites/serum ratios and confirm pancreatic source)
    • Ascitic fluid lipase (more specific for pancreatic disease than amylase)
    • CT scan of abdomen and pelvis (evaluates pancreatic structure, pseudocysts, and complications)
    • Abdominal ultrasound (visualizes pancreatic abnormalities and pseudocysts)
    • ERCP (endoscopic retrograde cholangiopancreatography) - if pseudocyst communication suspected
    • MRI/MRCP (magnetic resonance imaging for detailed pancreatic ductal anatomy)
    • Ascitic fluid cell count and differential (evaluates for infection or malignancy)
    • Ascitic fluid culture and sensitivity (rules out infection/peritonitis)
    • Ascitic fluid protein and albumin (assesses ascites type and etiology)
    • Serum albumin and liver function tests (evaluates liver disease contribution)
    • Blood glucose, creatinine, and BUN (assesses pancreatic and renal function)
    • Monitoring for Ongoing Conditions: Repeat paracentesis and amylase measurement every 24-72 hours if pancreatic rupture suspected (monitor for resolution); Imaging studies at 2-4 weeks for pseudocyst follow-up; Serial liver function tests if cirrhosis involved; Monthly monitoring if chronic pancreatitis with pseudocyst present
    • Complementary Tests: Prothrombin time (PT/INR) - assesses coagulation; BNP or echocardiogram if cardiac ascites suspected; Tumor markers (CA 19-9, CEA) if malignancy indicated; Prealbumin for nutritional assessment in chronic pancreatic disease
  • Fasting Required?
    • Fasting Requirement: NO - Fasting is not required for amylase measurement in ascitic fluid
    • Rationale: Since the specimen is collected directly from ascitic fluid via paracentesis (not blood), dietary intake does not affect the test; the amylase is present in the fluid itself regardless of fasting status
    • Special Preparation for Paracentesis Procedure:
    • Patient may need to empty bladder completely before procedure to reduce puncture risk
    • Sign informed consent form for invasive procedure
    • Report current medications including blood thinners (warfarin, heparin, aspirin, NSAIDs) to provider - may need to hold before procedure
    • Avoid eating and drinking only if sedation will be used during paracentesis
    • Wear comfortable, loose-fitting clothing to allow abdominal access
    • Arrange transportation home as driving is prohibited immediately after procedure due to sedation or discomfort
    • Medications to Report: Anticoagulants (warfarin, apixaban, dabigatran); Antiplatelet agents (aspirin, clopidogrel); NSAIDs; Corticosteroids; Antibiotics affecting results (inform lab)
    • Post-Procedure Instructions: Rest for 24 hours after paracentesis; Monitor puncture site for signs of infection; Report fever, persistent leakage, or severe pain; Resume normal diet after procedure unless otherwise instructed; Report abdominal distension or respiratory difficulty

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