Acute pancreatitis causes

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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]

Overview

There are many causes for acute pancreatitis. The most common causes are often taught using the mnemonic "I GET SMASHED" shown below. These causes include; idiopathic, alcohol, gallstones, trauma, steroids, scorpion bites, mumps, autoimmune diseases, ERCP, and certain medications.

Causes

Common 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
• 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.
• E - ethanol (alcohol)
• T - trauma
• S - steroids
• M - mumps (paramyxovirus) and other viruses (Epstein-Barr virus, Cytomegalovirus)
• A - autoimmune disease (Polyarteritis nodosa, Systemic lupus erythematosus)
• S - scorpion sting - Tityus Trinitatis - Trinidad/ snake bite
• H - hypercalcemia, hyperlipidemia/hypertriglyceridemia and hypothermia
• E - ERCP (Endoscopic Retrograde Cholangio-Pancreatography - a procedure that combines endoscopy and fluoroscopy)
• D - drugs (SAND - steroids & sulfonamides, azathioprine, NSAIDS, diuretics such as furosemide and thiazides, & didanosine) and duodenal ulcers

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, Linagliptin, Liraglutide, Mesalazine, Metronidazole, NSAIDS, Olsalazine, Oxyphenbutazone, 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

Abdominal surgery Abdominal trauma Apolipoprotein C-II deficiency Ascaris blocking pancreatic outflow Asparaginase Autoimmune diseases Azathioprine Bexarotene Bile duct cysts Bumetanide Campylobacter jejuni Chinese liver fluke Cholangiocarcinoma Choledochal cyst Choledocholithiasis Cholelithiasis Cholesterol embolism Coxsackie B virus Cystic fibrosis Cytomegalovirus Didanosine Diuretics Duodenal ulcer Endoscopic retrograde cholangiopancreatography Enfuvirtide Epstein-Barr virus Ethanol Excessive alcohol Exenatide Familial hypertriglyceridaemia Familial partial lipodystrophy type 1 Frusemide Gallstones Gastric ulcer Hereditary pancreatitis HIV-1 disease Human enterovirus B Hypercalcaemia

Hyperlipidemia Hypertriglyceridemia Hypothermia Idiopathic Ischemia from bypass surgery Linagliptin Lipoprotein lipase deficiency Liraglutide Long common duct Mesalazine Metronidazole Mumps Mycoplasma pneumoniae NSAIDS Olsalazine Oxyphenbutazone Pancreas divisum Pancreas duct obstruction Pancreatic abnormalities Pancreatic cancer Pancreatic cysts Pancreatic trauma Peptic ulcer Polyarteritis nodosa Primary hyperparathyroidism Repeated marathon running Reye syndrome Scorpion sting Sitagliptin Snake bite Steroids Sulfonamides Systemic lupus erythematosus Teniasis Thiazide Valproic acid Varicella-zoster virus Zinc