Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Emergency Medicine

Answer 5
  1. A single serum lipase value is a useful screening test for acute pancreatitis because of its high negative predicative value (0.99). An elevation of the leukocyte count favors a surgical cause of abdominal pain, whereas a normal leukocyte count favors a nonsurgical cause. However, the leukocyte count is neither sensitive nor specific enough to confirm appendicitis, even in patients with right lower quadrant pain. Most patients with acute abdominal pain warrant a urinalysis; however, an abnormal urinalysis does not exclude the diagnosis of appendicitis because pyuria and hematuria occur with both appendicitis and urinary tract infection. Physicians often view serum amylase as the gold standard for pancreatitis, ignoring other intra-abdominal conditions that provoke elevations in serum amylase such as biliary tract disease, appendicitis, perforated ulcer, intestinal obstruction, and mesenteric ischemia. The specificity of serum lipase for acute pancreatitis proves invariably higher than serum amylase, especially during the later phases of the disease when lipase levels remain elevated. Thus, the addition of serum amylase testing to serum lipase testing is usually not cost effective.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj