## Most Common Causes of Acute Pancreatitis **Key Point:** Alcohol and gallstones account for approximately 80–90% of all cases of acute pancreatitis in developed countries. In this patient with a significant alcohol history, alcohol is the most likely etiology. ### Epidemiology of Acute Pancreatitis Causes | Cause | Frequency | Clinical Context | |-------|-----------|------------------| | **Gallstones** | 40–50% | Biliary colic, female, older age | | **Alcohol** | 30–40% | Chronic consumption, male predominance | | Hypertriglyceridemia | 1–4% | Triglycerides >1000 mg/dL | | Medications | 0.5–2% | Drug-induced (azathioprine, valproate, etc.) | | Idiopathic | 10–15% | No identifiable cause | | Post-ERCP | 3–5% | Procedure-related | | Infections | <1% | Mumps, CMV, HIV | **High-Yield:** In India and other developing nations, the relative frequency of alcohol-related pancreatitis is rising due to increased alcohol consumption, whereas gallstone pancreatitis remains common in older populations. **Clinical Pearl:** Alcohol-induced pancreatitis typically occurs after chronic consumption (>5 years) and often presents with recurrent episodes. A single episode of pancreatitis in a heavy drinker strongly suggests alcohol as the etiology. **Mnemonic:** **GET SMASHED** — Gallstones, Endoscopy (post-ERCP), Trauma, Steroids, Mumps, Azathioprine, Scorpion sting, Hypercalcemia, Hypertriglyceridemia, Ethanol, Drugs. While this mnemonic lists causes, the two most common remain gallstones and alcohol globally. ### Why Alcohol in This Case? The patient's 10-year history of alcohol consumption is the dominant clinical clue. Alcohol is metabolized by the pancreas and generates toxic metabolites (acetaldehyde, free radicals) that directly injure acinar cells and promote inflammatory cascades. Chronic alcohol use also causes ductal obstruction via protein precipitation and fibrosis. [cite:Harrison 21e Ch 346]
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