Which of the investigation can itself lead to acute pancreatitis: March 2008
Ans. C: ERCP Causes of acute pancreatitis (I GET SMASHED): I - idiopathic. G - gallstone. Gallstones that travel down the common bile duct and which subsequently get stuck in the Ampulla of Vater can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum. The backflow of these digestive juices causes lysis (dissolving) of pancreatic cells and subsequent pancreatitis. E - ethanol (alcohol) T - trauma S - steroids M - mumps (paramyxovirus) and other viruses (Epstein-Barr virus, Cytomegalovirus) A - autoimmune disease (Polyaeritis nodosa, Systemic lupus erythematosus) S - scorpion sting (e.g. Tityus trinitatis), and also snake bites H - hypercalcemia, hyperlipidemia/hyperiglyceridemia and hypothermia E - ERCP (Endoscopic Retrograde Cholangio-Pancreatography) D - drugs (SAND - steroids and sulfonamides, azathioprine, NSAIDS, diuretics such as furosemide and thiazides, and didanosine) and duodenal ulcers. This mnemonic is also roughly arranged according to the frequency of its causes. Thus: Gallstone pancreatitis is more common than pancreatitis caused by alcohol, trauma, or steroids. Signs which are less common, and indicate severe disease, include: Grey-Turner's sign (hemorrhagic discoloration of the flanks) Cullen's sign (hemorrhagic discoloration of the umbilicus)
USG
CT scan
ERCP
MRI scan