(The) clinical significance of changes in duodenal aspirate enzymes in biliary and pancreatic disease
The object of this study was to compare the effects of duodenal stimulation using secretin, pancreozymin and the effect of heparin in six controls and vie patients with biliary or pancreatic disease. Measurements were made of the duodenal aspirate for amylase, lipase and trypsin as well as cholate and bilirubin.
Studies were made on six control persons who were thought to have normal biliary and pancreatic function. Two patients with cholelithiasis, two with chronic relapsing pancreatitis, one with acute pancreatitis and one with cirrhosis were selected for special study.
All subjects were examined in the fasting state after having been on normal diets. Under fluoroscopic control a Rehfuss tube was placed in the duodenum and a Levin tube in the stomach. Specimens were aspirated from each tube at ten minute intervals.
After the duodenal aspirate became crystal clear the secretions were collected continuously over a ten minute period. Then pancreozymin was injected intravenously, followed other drugs. In each case test samples were withdrawn every ten minute.
The following measurements were performed:
1. Amylase by Nelson's method (1944)
2. Lipase by Cherry and Crandall method(1932)
3. Trypsin by Anson's method(1938)
4. Bilirubin by the modified White's method(1958)
5. Cholate by Irvin et al method(1944)
The results can be summarized as follows: (See Table 1)
1. In control group:
Volume 2.4 ml/kg
Amylase 236.5 m./cc
Lipase 28.1 ml/cc
Trypsin 20.5 mg/cc
Cholate 50.3 mg/100cc
Bilirubin 10.4 mg/100cc
2. In cholelithiasis the enzymatic changes in the duodenal aspirate were similar.
However, the cholate was 31.5 mg/100cc and the bilirubin also decreased to 5.1mg/100cc.
3. In chronic relapsing pancreatitis the volume of duodenal aspirate was markedly decreased to 1.5 ml/kg.
The enzymes were also decreased to:
Amylase 51.7 ml/kg
Lipase 10.9 ml/cc
Trypsin 13.8 mg/cc