Acute pancreatitis causes: Difference between revisions

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__NOTOC__
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{{Acute pancreatitis}}
{{Acute pancreatitis}}
{{CMG}}; {{AE}} {{RT}}; {{TarekNafee}}
==Overview==
Acute pancreatitis may be either idiopathic or caused by [[alcohol]], [[gallstones]], [[trauma]], [[steroids]], [[mumps]], [[autoimmune diseases]], [[ERCP]], [[hypercalcemia]], [[hyperlipidemia]], [[hypertriglyceridemia]] or certain medications. Gallstones are the most common cause of acute pancreatitis, followed by chronic alcohol consumption (4-5 drinks daily for ~5 years). There are numerous primary and secondary causes of acute pancreatitis that must be considered in a patient's work up.


{{CMG}}; {{AE}} {{RT}}
==Causes==
[[Gallstones]] are the most common cause of [[acute pancreatitis]], followed by chronic [[alcohol]] consumption (4-5 drinks daily for ~5 years).<ref name="pmid170799342">{{cite journal| author=Yadav D, Lowenfels AB| title=Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. | journal=Pancreas | year= 2006 | volume= 33 | issue= 4 | pages= 323-30 | pmid=17079934 | doi=10.1097/01.mpa.0000236733.31617.52 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17079934  }}</ref> However; there are numerous primary and secondary causes of acute pancreatitis that must be considered in a patient's work up.<ref name="acutepancreatitis">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>


== Overview ==
=== Synopsis ===
The following table summarizes the most common causes of acute pancreatitis:<ref name="acutepancreatitis2">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>
{| class="wikitable"
!Cause
!Frequency
!Comment
|-
|[[Gallstones]]
|40%
|[[Gallstone disease|Gallstones]] or sludge
|-
|[[Alcohol]]
|30%
|4-5 drinks daily for 5 years
|-
|[[Hypertriglyceridemia]]
|2-5%
|>1000 mg/dL
|-
|[[Genetics|Genetic]]
|unknown
|Causing recurrent acute or chronic pancreatitis
|-
|Drug-induced
|<5%
|Most commonly [[azathioprine]], [[6-mercaptopurine]], [[didanosine]], [[valproic acid]], [[ACE inhibitor|ACEi]], [[mesalamine]]
|-
|[[Autoimmune]]
|<1%
|Presents as Type I or Type II
|-
|[[Endoscopic retrograde cholangiopancreatography|ERCP]] (Iatrogenic)
|5-10% of procedures
|Treated with rectal [[Non-steroidal anti-inflammatory drug|NSAIDs]] or temporary pancreatic duct stent placement
|-
|[[Trauma]]
|Blunt force trauma to the mid-abodmen
|Blunt force trauma to the mid-abdomen
|-
|[[Infection]]
|<1%
|Primarily caused by [[CMV infection|CMV]], [[mumps]], or [[EBV]].
May be caused by [[Ascariasis|ascaris]] or [[clonorchis]]
|-
|Surgical
|5-10% of patients on [[cardiopulmonary bypass]]
| -
|-
|Obstruction
|Rare
|Caused by [[celiac disease]], [[crohn's disease]], and perpetrated by pancreas divisium or [[sphincter of Oddi dysfunction]]
|}


== Causes ==
==== Anatomical causes ====
[[Sphincter of Oddi dysfunction]] and pancreas divisium have been traditionally associated with the development of acute pancreatitis; however, recent data suggests otherwise.<ref name="pmid229821832">{{cite journal| author=Coté GA, Imperiale TF, Schmidt SE, Fogel E, Lehman G, McHenry L et al.| title=Similar efficacies of biliary, with or without pancreatic, sphincterotomy in treatment of idiopathic recurrent acute pancreatitis. | journal=Gastroenterology | year= 2012 | volume= 143 | issue= 6 | pages= 1502-1509.e1 | pmid=22982183 | doi=10.1053/j.gastro.2012.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22982183  }}</ref> Pancreas divisium has been associated with [[genetic mutations]] that may be the true underlying cause of pancreatitis. Alternatively, the presence of the abnormal anatomy alone may not predispose patients to acute pancreatitis; however, in lieu of a [[genetic mutation]] may superimpose on the existing anatomical variation to contribute in the pathogenesis of acute pancreatitis.<ref name="pmid22306946">{{cite journal| author=DiMagno MJ, Dimagno EP| title=Pancreas divisum does not cause pancreatitis, but associates with CFTR mutations. | journal=Am J Gastroenterol | year= 2012 | volume= 107 | issue= 2 | pages= 318-20 | pmid=22306946 | doi=10.1038/ajg.2011.430 | pmc=3458421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22306946  }}</ref><ref name="acutepancreatitis3">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>


=== Common Causes ===
==== Environmental causes ====
[[Chronic alcoholism]] and smoking have been associated with the development of acute pancreatitis. Though [[alcohol]] has been proposed to be pathogenic in combination with the presence of an underlying [[genetic mutation]]. Alcoholism causing pancreatitis is more common in males than females. This may be due to the propensity of males to consume alcohol more than females, or due to the [[genetic mutations]] occurring more commonly in males.<ref name="pmid21029787">{{cite journal| author=Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR et al.| title=Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. | journal=Clin Gastroenterol Hepatol | year= 2011 | volume= 9 | issue= 3 | pages= 266-73; quiz e27 | pmid=21029787 | doi=10.1016/j.cgh.2010.10.015 | pmc=3043170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21029787  }}</ref><ref name="acutepancreatitis4">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>


==== Iatrogenic causes ====
Common iatrogenic causes of pancreatitis include [[Endoscopic retrograde cholangiopancreatography|ERCP procedures]] as well as use of medication. Hundreds of medications have been implicated in causing pancreatitis; however, the most common drugs include:<ref name="pmid18209761">{{cite journal| author=Kaurich T| title=Drug-induced acute pancreatitis. | journal=Proc (Bayl Univ Med Cent) | year= 2008 | volume= 21 | issue= 1 | pages= 77-81 | pmid=18209761 | doi= | pmc=2190558 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209761  }} </ref><ref name="acutepancreatitis5">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>
* [[Steroid]] use
* [[Azathioprine]]
* 6-[[Mercaptopurine]]
* [[Didanosine]]
* [[Valproic acid]]
* [[Angiotensin Converting Enzyme inhibitor|Angiotensin Converting Enzyme inhibitors]] ([[ACE inhibitor|ACEi]])
* [[Mesalamine]]
It is extremely difficult to identify a particular drug which may be responsible for the development of pancreatitis as there are usually multiple possibilities to the underlying etiology of the pancreatitis in patients with comorbidities; however, patients hospitalized for acute pancreatitis are often found to be using one or more drugs associated with the development of the disease.<ref name="pmid26335010">{{cite journal| author=Bertilsson S, Kalaitzakis E| title=Acute Pancreatitis and Use of Pancreatitis-Associated Drugs: A 10-Year Population-Based Cohort Study. | journal=Pancreas | year= 2015 | volume= 44 | issue= 7 | pages= 1096-104 | pmid=26335010 | doi=10.1097/MPA.0000000000000406 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26335010  }}</ref><ref name="acutepancreatitis7">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>
==== Genetic causes ====
Several [[genes]] have been proposed to play a role in the pathogenesis of [[acute pancreatitis]]. While the exact role of every implicated [[genetic mutation]] is not fully understood, the following genes have been associated with the development of acute pancreatitis:<ref name="pmid23622139">{{cite journal| author=Whitcomb DC| title=Genetic risk factors for pancreatic disorders. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 6 | pages= 1292-302 | pmid=23622139 | doi=10.1053/j.gastro.2013.01.069 | pmc=3684061 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23622139  }}</ref><ref name="acutepancreatitis6">{{cite journal
| last      = Forsmark
| first      = Chris E.
| last2      = Vege
| first2    = Santhi Swaroop
| last3      = Wilcox
| first3    = Mel
| date      = November 17,2016
| title      = Acute Pancreatitis
| url        = http://www.nejm.org/doi/full/10.1056/NEJMra1505202
| journal    = The New England Journal of Medicine
| volume    =
| issue      =
| pages      = 1972 - 1981
| doi        = 10.1056/NEJMra1505202
| pmc        =
| pmid      =
| access-date = November 25,2016
| name-list-format = vanc
}}</ref>
* [[CFTR]]
* [https://en.wikipedia.org/wiki/Trypsin_1 PRSS-1]
* [https://en.wikipedia.org/wiki/SPINK1 SPINK-1]
* [https://en.wikipedia.org/wiki/Chymotrypsin-C Chymotrypsin C]
* [https://en.wikipedia.org/wiki/CLDN2 Claudin-2]
* [https://en.wikipedia.org/wiki/Calcium-sensing_receptor Calcium sensing receptors]
===Common Causes===
A common [[mnemonic]] for the causes of pancreatitis spells "I get smashed", an allusion to heavy drinking (one of the many causes):  
A common [[mnemonic]] for the causes of pancreatitis spells "I get smashed", an allusion to heavy drinking (one of the many causes):  
*I - [[idiopathic]]
*I - [[idiopathic]]
*G - [[gallstone]]. Gallstones that travel down the common [[bile duct]] and which subsequently get stuck in the [[Ampulla of Vater]] can cause obstruction in the outflow of pancreatic juices from the pancreas into the [[duodenum]]. The backflow of these digestive juices causes lysis (dissolving) of pancreatic cells and subsequent pancreatitis.
*G - [[gallstone]]. [[Gallstones]] that travel down the common [[bile duct]] and which subsequently get stuck in the [[Ampulla of Vater|ampulla of vater]] can cause obstruction in the outflow of pancreatic juices from the pancreas into the [[duodenum]]. The back-flow of these digestive juices causes lysis (dissolving) of pancreatic cells and subsequent pancreatitis.
*E - [[ethanol]] ([[alcoholic beverage|alcohol]])
*E - [[ethanol]] ([[alcohol]]) - [[Alcohol]] has been proposed to cause acute pancreatitis in combination with genetic factors. It is more commonly a cause in males than females. This may be due to the propensity of males to chronically abuse alcohol, or by genetic factors more commonly present in males.
*T - [[physical trauma|trauma]]
*T - [[physical trauma|trauma]]
*S - [[steroids]]
*S - [[steroids]] - Commonly used in patients with [[Autoimmune disease|autoimmune diseases.]] Type I presents with obstructive [[jaundice]] and elevated [[IgG4-related systemic disease|IgG4]] levels. Type II presents in younger patients with no increase in [[IgG4-related systemic disease|IgG4]] levels.
*M - [[mumps]] ([[paramyxovirus]]) and other viruses ([[Epstein-Barr virus]], [[Cytomegalovirus]])
*M - [[mumps]] ([[paramyxovirus]]) and other viruses ([[Epstein-Barr virus]], [[Cytomegalovirus]])
*A - [[autoimmune disease]] ([[Polyarteritis nodosa]], [[Systemic lupus erythematosus]])
*A - [[autoimmune disease]] ([[Polyarteritis nodosa]], [[Systemic lupus erythematosus]])
*S - scorpion sting - Tityus Trinitatis - Trinidad/ snake bite
*S - scorpion sting - Tityus Trinitatis - Trinidad/ snake bite
*H - [[hypercalcemia]], [[hyperlipidemia]]/[[hypertriglyceridemia]] and [[hypothermia]]
*H - [[hypercalcemia]], [[hyperlipidemia]]/[[hypertriglyceridemia]] and [[hypothermia]]
*E - [[ERCP]] ('''E'''ndoscopic '''R'''etrograde '''C'''holangio-'''P'''ancreatography - a procedure that combines [[endoscopy]] and [[fluoroscopy]])
*E - [[ERCP]] (''E''ndoscopic ''R''etrograde ''C''holangio-''P''ancreatography - a procedure that combines [[endoscopy]] and [[fluoroscopy]])
*D - [[Medication|drugs]] ('''SAND''' - [[steroids]] & [[sulfonamides]], [[azathioprine]], [[NSAIDS]], [[diuretics]] such as [[furosemide]] and [[thiazides]], & [[didanosine]]) and [[duodenal ulcer]]s
*D - [[Medication|drugs]] (''SAND'' - [[steroids]] & [[sulfonamides]], [[azathioprine]], [[NSAIDS]], [[diuretics]] such as [[furosemide]] and [[thiazides]], & [[didanosine]]) and [[duodenal ulcer]]s. Drugs often present with mild pancreatitis and rarely are associated with signs of [[drug allergy]] such as [[rash]].


=== Causes by Organ System ===
===Causes by Organ System===
 
{| style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | [[Cholesterol embolism]], [[Polyarteritis nodosa]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cholesterol embolism]], [[Polyarteritis nodosa]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Scorpion sting]], [[Snake bite]], [[Zinc]], [[Ethanol]]
| bgcolor="Beige" | [[Scorpion sting]], [[Snake bite]], [[Zinc]], [[Ethanol]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Asparaginase]], [[Azathioprine]], [[Bexarotene]], [[Bumetanide]], [[Didanosine]], [[Diuretics]], [[Enfuvirtide]], [[Ethanol]], [[Exenatide]], [[Frusemide]], [[Linagliptin]], [[Liraglutide]], [[Mesalazine]], [[Metronidazole]], [[NSAIDS]], [[Olsalazine]], [[Oxyphenbutazone]], [[Sitagliptin]], [[Steroids]], [[Sulfonamides]], [[Thiazide]], [[Valproic acid]]
| bgcolor="Beige" | [[Asparaginase]], [[Azathioprine]], [[Bexarotene]], [[Bumetanide]], [[Didanosine]], [[Diuretics]], [[Enfuvirtide]], [[Ethanol]], [[Exenatide]], [[Frusemide]], [[Isotretinoin]], [[Linagliptin]], [[Liraglutide]], [[Mesalazine]], [[Metronidazole]], [[NSAIDS]], [[Olsalazine]], [[Oxyphenbutazone]], [[Pentamidine]], [[Sitagliptin]], [[Steroids]], [[Sulfonamides]], [[Thiazide]], [[Valproic acid]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| [[Primary hyperparathyroidism ]]
| bgcolor="Beige" | [[Primary hyperparathyroidism ]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Bile duct cysts]],[[Cholangiocarcinoma]], [[Choledochal cyst]], [[Choledocholithiasis]], [[Cholelithiasis]], [[Duodenal ulcer]], [[Gallstones ]], [[Gastric ulcer]], [[Long common duct]], [[Pancreas divisum]], [[Pancreas duct obstruction]], [[Pancreatic abnormalities]], [[Pancreatic cancer]], [[Pancreatic cysts ]], [[Peptic ulcer ]], [[Reye syndrome]], [[Hereditary pancreatitis]], [[Cystic fibrosis]]
| bgcolor="Beige" | [[Bile duct cysts]],[[Cholangiocarcinoma]], [[Choledochal cyst]], [[Choledocholithiasis]], [[Cholelithiasis]], [[Duodenal ulcer]], [[Gallstones ]] , [[Gastric ulcer]], [[Long common duct]], [[Pancreas divisum]], [[Pancreas duct obstruction]], [[Pancreatic abnormalities]], [[Pancreatic cancer]], [[Pancreatic cysts ]] , [[Peptic ulcer ]] , [[Reye syndrome]], [[Hereditary pancreatitis]], [[Cystic fibrosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[Apolipoprotein C-II deficiency]], [[Cystic fibrosis]], [[Familial hypertriglyceridaemia]], [[Familial partial lipodystrophy type 1 ]], [[Hereditary pancreatitis]], [[Lipoprotein lipase deficiency]]
| bgcolor="Beige" | [[Apolipoprotein C-II deficiency]], [[Cystic fibrosis]], [[Familial hypertriglyceridaemia]], [[Familial partial lipodystrophy type 1 ]] , [[Hereditary pancreatitis]], [[Lipoprotein lipase deficiency]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| [[Abdominal surgery ]], [[Endoscopic retrograde cholangiopancreatography]], [[Ischemia from bypass surgery]], [[Reye's syndrome]]
| bgcolor="Beige" | [[Abdominal surgery ]] , [[Endoscopic retrograde cholangiopancreatography]], [[Ischemia from bypass surgery]], [[Reye's syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Ascaris blocking pancreatic outflow]], [[Campylobacter jejuni]], [[Chinese liver fluke]], [[Coxsackie B virus]], [[Cytomegalovirus]], [[Epstein-Barr virus ]], [[HIV-1 disease]], [[Human enterovirus B]], [[Varicella zoster]], [[Mumps]], [[Mycoplasma pneumoniae]], [[Teniasis]], [[Varicella-zoster virus]]
| bgcolor="Beige" | [[Ascaris blocking pancreatic outflow]], [[Campylobacter jejuni]], [[Chinese liver fluke]], [[Coxsackie B virus]], [[Cytomegalovirus]], [[Epstein-Barr virus ]] , [[HIV-1 disease]], [[Human enterovirus B]], [[Varicella zoster]], [[Mumps]], [[Mycoplasma pneumoniae]], [[Teniasis]], [[Varicella-zoster virus]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Hypercalcaemia]], [[Hyperlipidemia]], [[Hypertriglyceridemia]], [[Lipoprotein lipase deficiency]], [[Apolipoprotein C-II deficiency]], [[Familial hypertriglyceridaemia]], [[Familial partial lipodystrophy type 1 ]]
| bgcolor="Beige" | [[Hypercalcaemia]], [[Hyperlipidemia]], [[Hypertriglyceridemia]], [[Lipoprotein lipase deficiency]], [[Apolipoprotein C-II deficiency]], [[Familial hypertriglyceridaemia]], [[Familial partial lipodystrophy type 1 ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[Cholangiocarcinoma]], [[Pancreatic cancer]]
| bgcolor="Beige" | [[Cholangiocarcinoma]], [[Pancreatic cancer]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Asparaginase]], [[Azathioprine]], [[Bexarotene]], [[Bumetanide]], [[Didanosine]], [[Diuretics]], [[Enfuvirtide]], [[Ethanol]], [[Exenatide]], [[Frusemide]], [[Linagliptin]], [[Liraglutide]], [[Mesalazine]], [[Metronidazole]], [[NSAIDS]], [[Olsalazine]], [[Oxyphenbutazone]], [[Sitagliptin]], [[Steroids]], [[Sulfonamides]], [[Thiazide]], [[Valproic acid]]
| bgcolor="Beige" | [[Asparaginase]], [[Azathioprine]], [[Bexarotene]], [[Bumetanide]], [[Didanosine]], [[Diuretics]], [[Enfuvirtide]], [[Ethanol]], [[Exenatide]], [[Frusemide]], [[Linagliptin]], [[Liraglutide]], [[Mesalazine]], [[Metronidazole]], [[NSAIDS]], [[Olsalazine]], [[Oxyphenbutazone]], [[Sitagliptin]], [[Steroids]], [[Sulfonamides]], [[Thiazide]], [[Valproic acid]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| [[Cystic fibrosis]]
| bgcolor="Beige" | [[Cystic fibrosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Autoimmune disease ]], [[Polyarteritis nodosa]], [[Sytemic lupus erythematosus]]
| bgcolor="Beige" | [[Autoimmune disease ]] , [[Polyarteritis nodosa]], [[Sytemic lupus erythematosus]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| [[Cystic fibrosis]]
| bgcolor="Beige" | [[Cystic fibrosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Abdominal trauma ]], [[Pancreatic trauma ]]
| bgcolor="Beige" | [[Abdominal trauma ]] , [[Pancreatic trauma ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Excessive alcohol]], [[Hypothermia]], [[Idiopathic]], [[Repeated marathon running]]
| bgcolor="Beige" | [[Excessive alcohol]], [[Hypothermia]], [[Idiopathic]], [[Repeated marathon running]]
|-
|-
|}
|}


=== Causes in Alphabetical Order ===
===Causes in Alphabetical Order===
 
{{MultiCol}}
{{MultiCol}}
*[[Abdominal surgery ]]
*[[Abdominal surgery ]]
Line 170: Line 379:
*[[Ethanol]]
*[[Ethanol]]
*[[Excessive alcohol]]
*[[Excessive alcohol]]
*[[Exenatide]]
*[[Exenatide]]<ref name="urlJAMA Network | JAMA Internal Medicine | Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes MellitusA Population-Based Matched Case-Control StudyGLP-1 and the Risk of Acute Pancreatitis">{{cite web |url=http://archinte.jamanetwork.com/article.aspx?articleid=1656537 |title=JAMA Network &#124; JAMA Internal Medicine &#124; Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes MellitusA Population-Based Matched Case-Control StudyGLP-1 and the Risk of Acute Pancreatitis |format= |work= |accessdate=2013-02-26}}</ref>
*[[Familial hypertriglyceridaemia]]
*[[Familial hypertriglyceridaemia]]
*[[Familial partial lipodystrophy type 1 ]]
*[[Familial partial lipodystrophy type 1 ]]
Line 186: Line 395:
*[[Idiopathic]]
*[[Idiopathic]]
*[[Ischemia from bypass surgery]]
*[[Ischemia from bypass surgery]]
*[[Isotretinoin]]
*[[Linagliptin]]
*[[Linagliptin]]
*[[Lipoprotein lipase deficiency]]
*[[Lipoprotein lipase deficiency]]
Line 209: Line 419:
*[[Reye syndrome]]
*[[Reye syndrome]]
*[[Scorpion sting]]
*[[Scorpion sting]]
*[[Sitagliptin]]
*[[Sitagliptin]]<ref name="urlJAMA Network | JAMA Internal Medicine | Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes MellitusA Population-Based Matched Case-Control StudyGLP-1 and the Risk of Acute Pancreatitis">{{cite web |url=http://archinte.jamanetwork.com/article.aspx?articleid=1656537 |title=JAMA Network &#124; JAMA Internal Medicine &#124; Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes MellitusA Population-Based Matched Case-Control StudyGLP-1 and the Risk of Acute Pancreatitis |format= |work= |accessdate=2013-02-26}}</ref>
*[[Snake bite]]
*[[Snake bite]]
*[[Steroids]]
*[[Steroids]]
Line 221: Line 431:
{{EndMultiCol}}
{{EndMultiCol}}


=== Complete differential diagnosis of causes of pancreatitis in alphabetic order ===
==References==
{{Reflist|2}}


In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
*Acute gestational fatty liver
*[[Alcoholism]]
*[[Aminoaciduria]]
*[[Ascarides]]
*[[Autoimmune pancreatitis]]
*[[Bacterial infection]]s
*Blunt [[Trauma]]
*[[Cholelithiasis]]
*[[Crohn's Disease]]
*[[Cystic fibrosis]]
*[[Duodenal diverticulum]]
*[[Drugs]]
**[[AIDS]] drugs such as [[Didanosine|DDI]] and [[Pentamidine]]
**[[Chemotherapeutic]] agents [[L-asparaginase]] and [[azathioprine]]
**[[Diuretics]] such as [[furosemide]] and [[hydrochlorothiazide]]
**[[Estrogen]]
*[[ERCP]]
*[[Fever]]
*[[Fungal infection]]s
*[[Hemochromatosis]]
*[[Hereditary pancreatitis]]
*[[Hypercalcemia]]
*[[Hypertriglyceridemia]]
*[[Hypotension]]
*[[Leukocytosis]]
*Necrotizing vascular angiitis
*Pancreatic cysts
*[[Pancreas divisum]]
*Partial pancreas resection
*Parasitic infections
*Penetrating [[trauma]]
*Penetrating gastrointestinal [[ulcer]]
*[[Porphyria]]s
**[[Hepatic porphyria|Acute hepatic porphyrias]]
**[[Acute intermittent porphyria]]
**[[Hereditary coproporphyria]]
**[[Variegate porphyria]]
**[[Erythropoietic protoporphyria]].
*Postoperative
*Posttransplantation
*[[Renal failure]]
*Stenosis of pancreatic ducts
*[[Systemic Lupus Erythematosus]]
*[[Thrombotic thrombocytopenic purpura]]
*[[Viral infection]]s such as [[mumps]]
== References ==
{{Reflist|2}}


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[[Category:Up-to-date]]

Latest revision as of 13:49, 9 October 2020

Acute pancreatitis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Tarek Nafee, M.D. [3]

Overview

Acute pancreatitis may be either idiopathic or caused by alcohol, gallstones, trauma, steroids, mumps, autoimmune diseases, ERCP, hypercalcemia, hyperlipidemia, hypertriglyceridemia or certain medications. Gallstones are the most common cause of acute pancreatitis, followed by chronic alcohol consumption (4-5 drinks daily for ~5 years). There are numerous primary and secondary causes of acute pancreatitis that must be considered in a patient's work up.

Causes

Gallstones are the most common cause of acute pancreatitis, followed by chronic alcohol consumption (4-5 drinks daily for ~5 years).[1] However; there are numerous primary and secondary causes of acute pancreatitis that must be considered in a patient's work up.[2]

Synopsis

The following table summarizes the most common causes of acute pancreatitis:[3]

Cause Frequency Comment
Gallstones 40% Gallstones or sludge
Alcohol 30% 4-5 drinks daily for 5 years
Hypertriglyceridemia 2-5% >1000 mg/dL
Genetic unknown Causing recurrent acute or chronic pancreatitis
Drug-induced <5% Most commonly azathioprine, 6-mercaptopurine, didanosine, valproic acid, ACEi, mesalamine
Autoimmune <1% Presents as Type I or Type II
ERCP (Iatrogenic) 5-10% of procedures Treated with rectal NSAIDs or temporary pancreatic duct stent placement
Trauma Blunt force trauma to the mid-abodmen Blunt force trauma to the mid-abdomen
Infection <1% Primarily caused by CMV, mumps, or EBV.

May be caused by ascaris or clonorchis

Surgical 5-10% of patients on cardiopulmonary bypass -
Obstruction Rare Caused by celiac disease, crohn's disease, and perpetrated by pancreas divisium or sphincter of Oddi dysfunction

Anatomical causes

Sphincter of Oddi dysfunction and pancreas divisium have been traditionally associated with the development of acute pancreatitis; however, recent data suggests otherwise.[4] Pancreas divisium has been associated with genetic mutations that may be the true underlying cause of pancreatitis. Alternatively, the presence of the abnormal anatomy alone may not predispose patients to acute pancreatitis; however, in lieu of a genetic mutation may superimpose on the existing anatomical variation to contribute in the pathogenesis of acute pancreatitis.[5][6]

Environmental causes

Chronic alcoholism and smoking have been associated with the development of acute pancreatitis. Though alcohol has been proposed to be pathogenic in combination with the presence of an underlying genetic mutation. Alcoholism causing pancreatitis is more common in males than females. This may be due to the propensity of males to consume alcohol more than females, or due to the genetic mutations occurring more commonly in males.[7][8]

Iatrogenic causes

Common iatrogenic causes of pancreatitis include ERCP procedures as well as use of medication. Hundreds of medications have been implicated in causing pancreatitis; however, the most common drugs include:[9][10]

It is extremely difficult to identify a particular drug which may be responsible for the development of pancreatitis as there are usually multiple possibilities to the underlying etiology of the pancreatitis in patients with comorbidities; however, patients hospitalized for acute pancreatitis are often found to be using one or more drugs associated with the development of the disease.[11][12]

Genetic causes

Several genes have been proposed to play a role in the pathogenesis of acute pancreatitis. While the exact role of every implicated genetic mutation is not fully understood, the following genes have been associated with the development of acute pancreatitis:[13][14]

Common Causes

A common mnemonic for the causes of pancreatitis spells "I get smashed", an allusion to heavy drinking (one of the many causes):

Causes by Organ System

Cardiovascular Cholesterol embolism, Polyarteritis nodosa
Chemical / poisoning Scorpion sting, Snake bite, Zinc, Ethanol
Dermatologic No underlying causes
Drug Side Effect Asparaginase, Azathioprine, Bexarotene, Bumetanide, Didanosine, Diuretics, Enfuvirtide, Ethanol, Exenatide, Frusemide, Isotretinoin, Linagliptin, Liraglutide, Mesalazine, Metronidazole, NSAIDS, Olsalazine, Oxyphenbutazone, Pentamidine, Sitagliptin, Steroids, Sulfonamides, Thiazide, Valproic acid
Ear Nose Throat No underlying causes
Endocrine Primary hyperparathyroidism
Environmental No underlying causes
Gastroenterologic Bile duct cysts,Cholangiocarcinoma, Choledochal cyst, Choledocholithiasis, Cholelithiasis, Duodenal ulcer, Gallstones , Gastric ulcer, Long common duct, Pancreas divisum, Pancreas duct obstruction, Pancreatic abnormalities, Pancreatic cancer, Pancreatic cysts , Peptic ulcer , Reye syndrome, Hereditary pancreatitis, Cystic fibrosis
Genetic Apolipoprotein C-II deficiency, Cystic fibrosis, Familial hypertriglyceridaemia, Familial partial lipodystrophy type 1 , Hereditary pancreatitis, Lipoprotein lipase deficiency
Hematologic No underlying causes
Iatrogenic Abdominal surgery , Endoscopic retrograde cholangiopancreatography, Ischemia from bypass surgery, Reye's syndrome
Infectious Disease Ascaris blocking pancreatic outflow, Campylobacter jejuni, Chinese liver fluke, Coxsackie B virus, Cytomegalovirus, Epstein-Barr virus , HIV-1 disease, Human enterovirus B, Varicella zoster, Mumps, Mycoplasma pneumoniae, Teniasis, Varicella-zoster virus
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic Hypercalcaemia, Hyperlipidemia, Hypertriglyceridemia, Lipoprotein lipase deficiency, Apolipoprotein C-II deficiency, Familial hypertriglyceridaemia, Familial partial lipodystrophy type 1
Obstetric/Gynecologic No underlying causes
Oncologic Cholangiocarcinoma, Pancreatic cancer
Opthalmologic No underlying causes
Overdose / Toxicity Asparaginase, Azathioprine, Bexarotene, Bumetanide, Didanosine, Diuretics, Enfuvirtide, Ethanol, Exenatide, Frusemide, Linagliptin, Liraglutide, Mesalazine, Metronidazole, NSAIDS, Olsalazine, Oxyphenbutazone, Sitagliptin, Steroids, Sulfonamides, Thiazide, Valproic acid
Psychiatric No underlying causes
Pulmonary Cystic fibrosis
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Autoimmune disease , Polyarteritis nodosa, Sytemic lupus erythematosus
Sexual Cystic fibrosis
Trauma Abdominal trauma , Pancreatic trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Excessive alcohol, Hypothermia, Idiopathic, Repeated marathon running

Causes in Alphabetical Order


References

  1. ↑ Yadav D, Lowenfels AB (2006). "Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review". Pancreas. 33 (4): 323–30. doi:10.1097/01.mpa.0000236733.31617.52. PMID 17079934.
  2. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  3. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  4. ↑ Coté GA, Imperiale TF, Schmidt SE, Fogel E, Lehman G, McHenry L; et al. (2012). "Similar efficacies of biliary, with or without pancreatic, sphincterotomy in treatment of idiopathic recurrent acute pancreatitis". Gastroenterology. 143 (6): 1502–1509.e1. doi:10.1053/j.gastro.2012.09.006. PMID 22982183.
  5. ↑ DiMagno MJ, Dimagno EP (2012). "Pancreas divisum does not cause pancreatitis, but associates with CFTR mutations". Am J Gastroenterol. 107 (2): 318–20. doi:10.1038/ajg.2011.430. PMC 3458421. PMID 22306946.
  6. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  7. ↑ Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR; et al. (2011). "Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis". Clin Gastroenterol Hepatol. 9 (3): 266–73, quiz e27. doi:10.1016/j.cgh.2010.10.015. PMC 3043170. PMID 21029787.
  8. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  9. ↑ Kaurich T (2008). "Drug-induced acute pancreatitis". Proc (Bayl Univ Med Cent). 21 (1): 77–81. PMC 2190558. PMID 18209761.
  10. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  11. ↑ Bertilsson S, Kalaitzakis E (2015). "Acute Pancreatitis and Use of Pancreatitis-Associated Drugs: A 10-Year Population-Based Cohort Study". Pancreas. 44 (7): 1096–104. doi:10.1097/MPA.0000000000000406. PMID 26335010.
  12. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  13. ↑ Whitcomb DC (2013). "Genetic risk factors for pancreatic disorders". Gastroenterology. 144 (6): 1292–302. doi:10.1053/j.gastro.2013.01.069. PMC 3684061. PMID 23622139.
  14. ↑ Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  15. ↑ 15.0 15.1 "JAMA Network | JAMA Internal Medicine | Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes MellitusA Population-Based Matched Case-Control StudyGLP-1 and the Risk of Acute Pancreatitis". Retrieved 2013-02-26.


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