Acute pancreatitis causes

Jump to: navigation, search

Acute pancreatitis Microchapters

Home

American College of Gastroenterology Guidelines

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute Pancreatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Approach to Therapy

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute pancreatitis causes On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute pancreatitis causes

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute pancreatitis causes

CDC on Acute pancreatitis causes

Acute pancreatitis causes in the news

Blogs on Acute pancreatitis causes

Directions to Hospitals Treating Acute pancreatitis

Risk calculators and risk factors for Acute pancreatitis causes

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. PMID 17079934. doi:10.1097/01.mpa.0000236733.31617.52. 
  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. 
  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. 
  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. PMID 22982183. doi:10.1053/j.gastro.2012.09.006. 
  5. DiMagno MJ, Dimagno EP (2012). "Pancreas divisum does not cause pancreatitis, but associates with CFTR mutations.". Am J Gastroenterol. 107 (2): 318–20. PMC 3458421Freely accessible. PMID 22306946. doi:10.1038/ajg.2011.430. 
  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. 
  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. PMC 3043170Freely accessible. PMID 21029787. doi:10.1016/j.cgh.2010.10.015. 
  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. 
  9. Kaurich T (2008). "Drug-induced acute pancreatitis.". Proc (Bayl Univ Med Cent). 21 (1): 77–81. PMC 2190558Freely accessible. 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. 
  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. PMID 26335010. doi:10.1097/MPA.0000000000000406. 
  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. 
  13. Whitcomb DC (2013). "Genetic risk factors for pancreatic disorders.". Gastroenterology. 144 (6): 1292–302. PMC 3684061Freely accessible. PMID 23622139. doi:10.1053/j.gastro.2013.01.069. 
  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. 
  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. 




Linked-in.jpg