Etiologies-acute pancreatitis

(JAMA 2021;325:382)

詳見Acute Pancreatitis: A Review.

1. Gallstones (40%):

♀ >♂; usually due to small stones (<5 mm) or microlithiasis/sludge

2. Alcohol (30%):

♂ >♀; 4–5 drinks/day over ≥5 yrs; usually chronic w/ acute flares

3. Metabolic:

hypertrig. (2–5%; TG >1000; type I & V familial hyperlipemia); hypercalcemia

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• drugs as etiologies of acute pancreatitis (<5%): 5-ASA, 6-MP/AZA, ACEI, cytosine, didanosine, dapsone, estrogen, furosemide, isoniazid, MNZ, pentamidine, statins, sulfa, thiazides, tetracycline, valproate
• Anatomic: divisum, annular pancreas, duodenal duplication cysts, Sphincter of Oddi dysfxn
• Autoimmune (vide infra)
• Familial: suspect if age <20 y; (often a/w mutation in PRSS1, SPINK1 or CFTR gene)
• Infections: ascaris, clonorchis, coxsackie, CMV, EBV, HIV, mumps, mycoplasma, TB, toxo
• Ischemia: shock, vasculitis, cholesterol emboli
• Neoplastic: panc/ampullary tumors, mets (RCC most common, breast, lung, melanoma)
• Post ERCP (5%): Ppx w/ PR indomethacin can ↓ sx; temporary panc duct stent if high risk
• Trauma: blunt abdominal trauma, post-pancreatic/biliary surgery