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Acute pancreatitis is an acute inflammatory process of the pancreas that may involve surrounding tissue and remote organ systems. The disease can range from mild inflammation to severe extensive pancreatic necrosis and multi-organ failure with mortality rates of 20% to 30% or higher.1–3 Most cases are mild with a mortality rate <1% and resolve spontaneously with supportive care.4–6 Diagnosis can be difficult, because there is no pathognomonic clinical presentation and no diagnostic gold standard.7

Table 82-1 lists common causes of pancreatitis. The specific mechanism that triggers pancreatic inflammation remains unclear. Although the etiology varies with sex, age group, and country, gallstones (including microlithiasis) are the leading cause of acute pancreatitis, accounting for at least 35% to 40% of cases8,9 and significantly more than two thirds of cases in some regions.7

Table 82-1 Causes of Acute Pancreatitis

Alcohol use is the second most frequent cause.10 The association between alcohol consumption and acute pancreatitis is not well understood. The incidence in alcoholics is surprisingly low, which indicates not only that the amount of alcohol ingested is important but that unknown factors affect susceptibility to the injury.11

Other causes of acute pancreatitis are uncommon, situational, or subject to controversy (such as pancreas divisum or Oddi sphincter dysfunction). About 5% of patients are at risk of developing acute pancreatitis within 30 days after endoscopic retrograde cholangiopancreatography (ERCP).12 Hypertriglyceridemia is a rare cause (1% to 4%), and a serum level of >11 mmol/L can worsen attacks.13,14

Many drugs are reported to be associated with acute pancreatitis, but they account for only 1.4% to 2.0% of all cases. Drugs associated with pancreatitis are classified into three groups. Class I drugs are those associated with ≥20 case reports with at least one drug reexposure. Class II drugs are those described in ≥10 to 20 case reports with or without reexposure. All other drugs associated with the disease belong to Class III15 (Table 82-2).

Table 82-2 Drugs Associated with Acute Pancreatitis

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