Introduction

The term 'Acute abdomen' refers to signs and symptoms of abdominal pain and tenderness, a clinical presentation that may require emergency surgical therapy. This challenging scenario requires a thorough and expeditious workup to determine the need for operative: intervention and to initiate appropriate therapy. Many diseases, some of which are not surgical or intra-abdominal, can produce acute abdominal pain and tenderness. Therefore, every attempt is made to make a correct diagnosis so that the chosen therapy, often a laparoscopy or laparotomy, is appropriate. ¹

Acute abdomen is a broad term which includes many conditions, some requiring surgical management and others a conservative approach, e.g. conditions like perforated peptic ulcer, internal strangulation, perforation of hollow viscera, acute appendicitis etc need immediate surgical intervention, whereas in conditions like acute pancreatitis treatment is essentially conservative. Clinically it may be difficult to differentiate between these conditions as well as many other abdominal crisis. Hence the need for investigations may be biochemical, radiological or others.²

Need of the Study

Acute abdomen embraces a large group of pathological conditions which have very little in common with each other except that most of them present with acute abdominal pain and call for prompt diagnosis and treatment i.e. acute intestinal obstruction, acute appendicitis, perforated peptic ulcer, acute pancreatitis, renal colic, diverticulitis and gastritis.³ The variable presentation and severity of illness make it necessary to arrive at a provisional diagnosis on which a surgeon can act upon. Conditions like internal strangulation and perforation of hollow viscera demand immediate surgical intervention. At the same time there are other cases of acute abdomen of equally serious magnitude like acute pancreatitis, where the treatment is essentially conservative.⁴

1. Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery.18thedition: Philadelphia. Elsevier Publishing; 2008. P1180-98.
2. Hall ER, Howard JM, Jordan GL, Witt R. A study of serum III amylase concentration in patients with acute cholecystitis. Annals of Surgery 1956; 143(4):517-19.
3. Amerson JR, Howard JM, Vowles KD. The amylase concentration in serum and peritoneal fluid following acute perforation of gastroduodenal ulcers. Ann Surg 1958;147(2):245-50.
4. Pace BW, Bank S, Wise L, Burson LC, Borrero E. Amylase Isoenzymes in acute abdomen: An adjunct in those patients with elevated total amylase. Am J Gastroenterology 1985;80(11):898
5. Lott JA, Patel ST, Sawhney AK, Kazmierczak SC, Love JE. Assays of serum lipase: Analytical and clinical considerations. Clin. Chem.1986; 32(7):1290-1302.
6. Elman R. The Variations of Blood Amylase during Acute Transient Disease ofThe Pancreas. Annals of Surgery 1937; 105(3):379-84.
7. Abruzzo JL, Homa M, Houck JC, Coffey RJ. Significance of the Annals of Surgery serum amylase determination. 1958; 147(6):921-8.
8. Vissers RJ, Abu-Laban RB, McHugh DF. Amylase and Lipase in the emergency department evaluation of acute pancreatitis. J of Emerg Medicine 1999;17(6):1027-37.
9. Roth M. Pancreatic enzymes other than amylase. Clinical Biochemistry 1979;12:272-4.
10. Hoffmann GE, Weiss L. Specific Serum Pancreatic Lipase Determination, with use of purified colipase. Clin Chern 1980;26(12):1732-3.
11. Pieper-Bigelow C, Strocchi A, Levitt MD. Where does serum amylase come from and where does it go? Gastroenterology clinics of North America 1990;19(4):793-810.
12. Cherry IS, Crandall LA. The specificity of pancreatic lipase: Its appearance in the blood after pancreatic Jury. Am J Physio 1932; 1 00:226-73.
13. Tietz NW, Borden T, Stepleton JD. An improved method for the determination of lipase in serum. Am J of Clinical Pathology 1959;31 (2): 148-54.
14. Yadav D, Agarwal N, Pitchumoni CS. A critical evaluation of laboratory tests in acute pancreatitis. Am J of Gastroenterology 2002;97(6): 1309-18.
15. Gumaste VV, Roditis N, Mehta D. Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis. Am J Gastroenterology 1993;88(12):2051-55.
16. Chase CW, Barker DE, Russel WL, Burns RP. Serum amylase and lipase in the evaluation of acute abdominal pain. Am Surg 1996;62(12): 1028-33.
17. Munoz A, Katerndahl DA. Diagnosis and management of Acute Pancreatitis. Am Fam Physician 2000;62(1):164-74.
18. Salt WB, Schenker S. Amylase-its clinical significance: A review of the literature. Medicine 1976;55:269-89.
19. Clavien P A, Burgan S, Moossa AR. Serum Enzymes and other laboratory tests III acute pancreatitis. Br J Surg 1989;76(12): 1234-43.
20. Warshaw hyperamylasemia, probably neither pancreatic nor pathologic. Am J Surg 1988;155:453-56.
21. Agarwal N, Pitchumoni CS, Sivaprasad AV. Evaluating tests for Acute Pancreatitis. Am J of Gastroenterology 1990;85(4):356-64.
22. Wong ECC, Butch AW, Rosenblum JL, Ladenson JR, Scott MG. The clinical · chemistry laboratory and acute pancreatitis. Clin Chern 1993;39(12):234-43.
23. Tietz NW, Shuey DF. Lipase in Serum-the Elusive enzyme:An overview. Clin Chern 1993;39(5):746-56.
24. Apple F, Benson P, Preese L, Eastep S. Lipase and pancreatic amylase activities in tissues and patients with hyperamylasemia. Am J Clin Path 1991;96(5):610-44.
25. Moller-Peterson J, Dati F. Renal handling of pancreatic lipase. Clin Chern 1984;30:343-44.

Kapil Sindhu

Assistant Professor, Dept. of Surgery, MMIMSR, Mullana Ambala 133207