There are multiple causes for acute pancreatitis, but two factors account for almost 90% of all attacks:
1. Gallstones, which cause acute biliary pancreatitis and are especially common in females
2. Alcohol, which is the most common cause of acute pancreatitis in males
Both of these forms of pancreatitis are related to environmental factors.
Gallstones are extremely common in developed countries, but the prevalence of gallstones varies widely throughout the world. They are more common in females than in males and become more common with increasing age. Gallstones form in the gallbladder, and when they are confined to this organ, they cause acute cholecystitis, rather than pancreatitis. But severe pancreatitis can occur if gallstones enter the common bile duct and obstruct the opening of the pancreatic duct. Fortunately, only a small percentage of patients with gallstone disease, perhaps 1 or 2%, ever develop pancreatitis. Small gallstones are often found in patients who develop biliary pancreatitis.
What are some of the environmental factors leading to the formation of gallstones? Numerous studies have determined that the major risk factor causing cholelithiasis is obesity. Both male and females who are overweight have an increased risk of cholelithiasis. In addition, weight reduction, perhaps by altering lipid excretion, can lead to the onset of symptomatic gallstone disease. In many countries, obesity is becoming a widespread problem, so it is reasonable to predict that the frequency of gallstones and biliary pancreatitis will increase.
If obesity is a major cause for gallstone disease, then exercise, an important weight control measure, should be beneficial. Leitzmann and coworkers investigated this hypothesis in a cohort study of 45,813 male health professionals.2 Based on their findings, they estimated that approximately one-third of all cases of symptomatic gallstone disease could be prevented by about half an hour of exercise five times per week.
Many other risk factors have been investigated as a potential cause of cholelithiasis, but in most reports have not been found to be major contributory causes. In particular, smoking does not appear to be related to gallstone formation, whereas alcohol consumption may reduce the frequency of gallstones. Oral contraceptives do not seem to be related to gallstones.3 Surprisingly, serum lipid levels may be negatively correlated with the presence of gallstones, although hyperlipidemia is sometimes associated with acute pancreatitis.
Excess alcohol consumption is the most common cause of acute pancreatitis in men (see Chapter 15). One or two episodes of acute alcoholic intoxication do not cause pancreatitis, but acute pancreatitis can be the first manifestation of pancreatic disease in heavy drinkers. Chronic pancreatitis is likely to develop, if these patients continue to drink. The exact mechanism by which alcohol damages the pancreas is unclear, although it is known that alcohol can stimulate pancreatic exocrine secretion.
In addition to gallstones and alcohol, there are several other environmental factors that occasionally cause acute pancreatitis. Parasitic disease such as ascariasis can cause acute pancreatitis, if, as sometimes happens, one of the worms migrates out of the digestive tract and enters the pancreatico-biliary system. Several viral infections such as mumps, infectious mono-nucleosis, Coxsackie B virus, and fulminant viral hepatitis sometimes cause acute pancreatitis. In addition, drug therapy for human immunodeficiency virus (HIV) infection can cause pancreatitis.
During the past few decades, ERCP has become a popular procedure for investigating the pancreatico-biliary system. Unfortunately, even when performed by a skilled endoscopist, this procedure can lead to acute pancreatitis in approximately 5 to 10% of patients.
Exposure to therapeutic drugs is another environmental cause for acute pancreatitis. Drugs known to cause pancreatitis can be classified in several categories, including antibiotics, diuretics, chemotherapeutic agents, and antiviral agents.4 Sometimes a single exposure to an agent, such as tetracycline, causes pancreatitis; for other toxic drugs, the results are dose-dependent.
In addition to drug exposure, there have been a few cases of pancreatitis resulting from exposure to either industrial poisons, such as par-athion, or natural toxins from spider bites or other insect stings.
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Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.