Which of the following is the most common nonalcholic cause of acute pancreatitis
Aetiology of Acute pancreatitis The two major causes of acute pancreatitis are biliary calculi, which occur in 50-70% of patients, and alcohol abuse, whichaccounts for 25% of cases. Gallstone pancreatitis is thought to be triggered by the passage of gallstones down the common bile duct. If the biliary and pancreatic ducts join to share a common channel before ending at the ampulla, then obstruction of this passage may lead to reflux of bile or activated pancreatic enzymes into the pancreatic duct. Patients who have small gallstones and a wide cystic duct may be at a higher risk of passing stones. The proposed mechanisms for alcoholic pancreatitis include the effects of diet, malnutrition, direct toxicity of alcohol, concomitant tobacco smoking, hypersecretion, duct obstruction or reflux, and hyperlipidaemia. The remaining cases may be due to rare causes or be idiopathic.Among patients who undergo ERCP, 1-3% develop pancreatitis, probably as a consequence of duct disruption and enzyme extravasation. Patients with sphincter of Oddi dysfunction or a history of recurrent pancreatitis, and those who undergo sphincterotomy or balloon dilatation of the sphincter, carry a higher risk of developing post-ERCP pancreatitis. Patients who have undergone upper abdominal or cardiothoracic surgery may develop acute pancreatitis in the postoperative phase, as may those who have suffered blunt abdominal trauma. Hereditary pancreatitis is a rare familial condition associated with mutations of the cationic trypsinogen gene. Patients have a tendency to suffer acute pancreatitis while in their teens, progress to chronic pancreatitis in the next two decades and have a high risk (possibly up to 40%) of developing pancreatic cancer by the age of 70 years. Occasionally, tumours at the ampulla of Vater may cause acute pancreatitis. It is impoant to check the serum calcium level, a fasting lipid profile, autoimmune markers and viral titres in patients with so called idiopathic acute pancreatitis. It is equally impoant to take a detailed drug history and remember the association of coicosteroids, azathioprine, asparaginase and valproic acid with acute pancreatitis. Statins (taken over a long time) and gliptins have been linked with pancreatitis, but the evidence is slim. It is essential to exclude tiny gallstones. A careful search for the aetiology must be made in all cases, and no more than 20% of cases should fall into the idiopathic category. Possible causes of acute pancreatitis * Gallstones * Alcoholism * Post ERCP * Abdominal trauma * Following biliary, upper gastrointestinal or cardiothoracic surgery * Ampullary tumour * Drugs (coicosteroids, azathioprine,asparaginase, valproic acid, thiazides, oestrogens) * Hyperparathyroidism * Hypercalcaemia * Pancreas divisum * Autoimmune pancreatitis * Hereditary pancreatitis * Viral infections (mumps, coxsackie B) * Malnutrition * Scorpion bite * Idiopathic Ref: Bailey and love 27th edition Pgno : 1222
Thiazides
Hypercalcaemia
Hyperlipidaemia
Gall stones
G.I.T