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Pancreatitis is an inflammatory process of the pancreas that may be limited to just the pancreas, may affect surrounding tissues, or may cause remote organ system dysfunction. Most patients will have only one episode of acute pancreatitis, whereas 15% to 30% will have at least one recurrence.1-3 Between 5% and 25% of patients will ultimately develop chronic pancreatitis.2,3

Most cases (~80%) involve only mild inflammation of the pancreas, a disease state with a mortality rate of <1%, which generally resolves with only supportive care.1,4 A small proportion of patients suffer from more severe disease that may involve pancreatic necrosis, inflammation of surrounding tissues, and organ failure.5,6

Factors associated with acute pancreatitis are listed in Table 79-1.7-11 Most cases are related to either gallstones or alcohol consumption. About 5% of all patients who undergo endoscopic retrograde cholangiopancreatography for treatment of gallstones develop pancreatitis within 30 days.7

TABLE 79-1Causes of Acute Pancreatitis

Alcohol use and pancreatitis have a complex relationship, thought to be founded in toxicity and immunologic mechanisms.12


Over 500 drugs have been linked to acute pancreatitis, but together, they account for fewer than 2% of cases. Table 79-2 lists the drugs found to be most well linked to acute pancreatitis based on number of case reports and recurrence after drug reexposure.13

TABLE 79-2Drugs Associated With Acute Pancreatitis13

Medications associated with acute pancreatitis can be categorized into three groups: antiretrovirals, chemotherapy, and immunosuppressants. Patients taking these medications are at particular risk of severe disease because of the underlying disease combined with the medication side effects. 2′,3′-Dideoxyinosine can cause potentially fatal pancreatitis, whereas patients receiving the antiretrovirals lamivudine and nelfinavir are at lower risk.13

Cancer patients undergoing chemotherapy with one or more of seven ...

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