Browse the corpus

©2013 UpToDate ® Print Email Approach to establishing the cause of acute pancreatitis Clinical profile Suspected cause Confirmatory testing Prior episodes of biliary colic and/or cholangitis, increased serum ALT and/or bilirubin during episode Gallstones Ultrasonography; ERCP/EUS/MRCP for common bile duct stones Long history (usually 10 to 20 years) of alcohol abuse Alcohol Plain film/CT scan for pancreatic calcification; blood glucose for diabetes; 72 hour fecal fat for steatorrhea; may require follow-up for definitive diagnosis High-risk group on medication known to cause pancreatitis and no other cause for pancreatitis; eg, patient with AIDS on DDI, with Crohn's disease on 6-mercaptopurine, on ACE inhibitor with history of angioedema Drug-induced pancreatitis Withdrawal of offending drug Child with family history of pancreatitis Familial hypertriglyceridemia or hereditary chronic pancreatitis Serum triglyceride concentration and genetic testing, respectively Adult with milky serum Hypertriglyceridemia Serum triglyceride concentration Recent ERCP, surgery or abdominal trauma Posttraumatic/post procedure Temporal relationship to event Hemorrhagic shock, recent vascular surgery, angiography, coronary artery bypass graft Vascular Temporal relationship to event; evidence of ischemic or atheroembolic injury to other organs; tissue biopsy may show evidence of atheroembolism and urine eosinophils Recurrent pancreatitis with hypercalcemia Hypercalcemia Hypercalcemia is an unusual cause of acute pancreatitis; exclude other causes first Hypertension, proteinuria, mononeuropathy, skin lesions Polyarteritis nodosa Biopsy of muscle, skin or nerve, angiography, ANCA Recurrent pancreatitis without obvious cause (idiopathic) Pancreas divisum* ERCP shows pancreas divisum; endoscopic or surgical sphincterotomy Sphincter of Oddi dysfunction* ERCP with manometry/MRCP with secretin ALT: alanine aminotransferase; ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasound; MRCP: magnetic resonance cholangiopancreatography; CT: computed tomography; DDI: didanosine; ACE: angiotensin converting enzyme; ANCA: antineutrophil cytoplasmic antibody. * See topic review "Etiology of acute pancreatitis" for a discussion regarding the relation to etiology of pancreatitis.