Causes of Pancreatitis: I GET SMASHED

Idiopathic (i.e microlithiasis) ·        

Gallstones

Endoscopic retrograde cholangiopancreatography (ERCP)        

Trauma (especially blunt abdominal trauma)·  

Scorpion bites (Tityus trinitatis, Trinidad)

Mumps. But also: CMV, EBV, HIV, Varicella, Rubella

Autoimmune (IBD, PAN, SLE) or Genetics (CFTR or Trypsin inhibitor)

Surgery (abdominal and non abdominal operations)·   

Hyperlipidemia (TG >10mmol/L or >1000mg/dL). Hypothermia, Hypercalcemia  

Ethanol alcohol (acute and chronic alcoholism) 

Drugs (azathioprine, 6-mercaptopurine, diuretics (e.g., thiazides, furosemide), estrogens/steroids, tetracycline, valproic acid, anti-HIV medications)    

NOTE:

• GALLSTONES continue to be the leading cause of pancreatic inflammation (30-60%); Larger the gallstone, the greater the risk of acute pancreatitis!
• ALCOHOL is the second most common cause (~30%)
• ERCP: 5-20% will have this as a post-operative complication

EACH MECHANISM IS NOT CLEARLY UNDERSTOOD!

Theory: AUTO-DIGESTION: proteolytic enzymes (e.g., trypsinogen, chymotrypsinogen, pro elastase, and lipolytic enzymes such as phospholipase A2) are activated in the pancreas rather than in the intestinal lumen. A number of factors (e.g., endotoxins, exotoxins, viral infections, ischemia, anoxia, lysosomal calcium, and direct trauma) are believed to facilitate activation of trypsin.

REFERENCES

1. Kaufman MB. Drug-induced pancreatitis: A Potentially Serious and Underreported Problem. Pharmacy and Therapeutics. 2013;38(6):349-351.
2. Bartholomew C. Acute Scorpion Pancreatitis in Trinidad. British Medical Journal. 1970;1(5697):666-668.
3. Kota SK, Kota SK, Jammula S, Krishna SVS, Modi KD. Hypertriglyceridemia-induced recurrent acute pancreatitis: A case-based review. Indian Journal of Endocrinology and Metabolism. 2012;16(1):141-143. doi:10.4103/2230-8210.91211.