Pancreatitis

Acute Pancreatitis

Pathogenesis

  • Pancreatic duct and acinar injury via direct or indirect toxicity → impaired secretion and premature activation of digestive enzymes → autodigestion and acute inflammation

Etiologies (NEJM 2016;375:1972)

  • Gallstones (40%): ♀ > ♂; usually due to small stones (<5 mm) or microlithiasis/sludge
  • Alcohol (30%): ♂ > ♀; 4–5 drinks/day over ≥5 yrs; usually chronic w/ acute flares
  • Metabolic: hypertrig. (2–5%; TG >1000; type I & V familial hyperlipemia); hyperCa
  • Drugs (<5%): 5-ASA, 6-MP/AZA, ACEI, cytosine, didanosine, dapsone, estrogen, furosemide, isoniazid, MNZ, pentamidine, statins, sulfa, thiazides, tetracycline, valproate
  • Anatomic: l duplication cysts, Sphincter of Oddi dysfxn