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causes of acute pancreatitis

Etiology: 1) common causes (90% of cases) a) alcoholism b) gallstone disease - microlithiasis 2) uncommon causes a) abdominal trauma (especially blunt trauma) b) postoperative state c) ERCP d) infections - viral infections: mumps, hepatitis B, coxsackie virus, echovirus, cytomegalovirus, Epstein-Barr virus - bacteria: Mycoplasma, Campylobacter, Mycobacterium avium complex (MAI, MAC) - parasitic: ascaris, toxoplasmosis e) metabolic - hyperlipidemia, hypertriglyceridemia - apolipoprotein CII deficiency - hypercalcemia - renal failure - fatty liver of pregnancy f) pharmacologic agents: [2,3] - drugs that increase serum triglycerides - glucocorticoids - oral contraceptives (estrogens) - thiazides (HCTZ), furosemide - HIV protease inhibitors - drugs that cause hypersensitivity - azathioprine, 6-mercaptopurine - tetracycline - sulfonamides, Bactrim - ACE inhibitors - drugs with toxic effect - valproic acid - statins (all statins) - sulindac - metformin - nucleoside reverse transcriptase inhibitors - dideoxyinosine (didanosine, ddI) - asparaginase - drugs that cause pancreatic spasm - opiates - octreotide - others - ethacrynic acid - pentamidine - mesalamine - agents probably associated with pancreatitis: - acetaminophen - nitrofurantoin - methyldopa - erythromycin - salicylates - metronidazole - NSAIDs g) biliary duct & pancreatic duct abnormalities h) obstruction of the ampulla of Vater - regional enteritis - duodenal diverticulum i) sphincter of Oddi dysfunction* j) ERCP k) ischemia - ischemic hypoperfusion after cardiac surgery - atherosclerotic emboli l) vasculitis - systemic lupus erythematosus (SLE) - systemic necrotizing vasculitis - thrombotic thrombocytopenic purpura m) penetrating peptic ulcer n) pancreas divisum* o) cystic fibrosis p) pancreatic cancer q) cholecochocele r) idiopathic 3) rare a) autoimmune pancreatitis b) viral infection - mumps, coxsacke B virus, cytomegalovirus c) parasitic infection - toxoplasmosis, ascariasis d) celiac disease * no convincing data from controlled trials that either pancreatic sphincter of Oddi dysfunction or pancreas divisum plays a role in acute pancreatitis [5]

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acute pancreatitis

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1742
  2. Prescriber's Letter 14(4): 2007 Drug-induced pancreatitis Detail-Document#: 230411 (subscription needed) http://www.prescribersletter.com
  3. Prescriber's Letter 16(11): 2009 COMMENTARY: Januvia (Sitagliptin) and Pancreatitis CHART: Drug-Induced Pancreatitis COMMENTARY: Pancreatitis and Byetta (Exenatide) Detail-Document#: 251025 (subscription needed) http://www.prescribersletter.com
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Forsmark CE, Vege SS, Wilcox CM Acute Pancreatitis N Engl J Med 2016; 375:1972-1981 November 17, 2016 PMID: 27959604 http://www.nejm.org/doi/full/10.1056/NEJMra1505202