## Most Common Causes of Acute Pancreatitis **Key Point:** Alcohol and gallstones together account for >80% of acute pancreatitis cases in developed countries. The distribution varies by geography and risk profile. ### Epidemiology by Cause | Cause | Frequency | Geographic Variation | Key Feature | |-------|-----------|----------------------|-------------| | **Gallstones** | 40–50% | Higher in developed nations | More common in females, older age | | **Alcohol** | 30–40% | Higher in males, chronic users | Recurrent episodes, chronic pancreatitis risk | | **Post-ERCP** | 3–5% | Procedure-related | Iatrogenic; preventable | | **Hypertriglyceridemia** | 1–3% | TG >1000 mg/dL | Metabolic; rare | | **Idiopathic** | 10–15% | Variable | Diagnosis of exclusion | **High-Yield:** In a patient with chronic alcohol use and acute pancreatitis, alcohol is the most likely cause. Gallstones are the single most common cause overall in the general population, but in a patient with documented heavy alcohol consumption and no mention of biliary disease, alcohol is the answer. ### Clinical Pearl **Warning:** Do not confuse "most common overall" (gallstones) with "most common in this specific patient" (alcohol). The stem provides a 15-year history of alcohol abuse — this clinical context makes alcohol the most likely etiology in this case. **Mnemonic:** **I GET SMASHED** — Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia, ERCP, Drugs. ### Mechanism Alcohol causes pancreatitis through: 1. Direct toxic injury to acinar cells 2. Increased pancreatic secretion and ductal obstruction 3. Oxidative stress and free radical formation 4. Chronic inflammation leading to fibrosis and chronic pancreatitis [cite:Harrison 21e Ch 367]
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