Acute Pancreatitis Etiology and Diagnosis

Primary Etiologies

Gallstones and alcohol abuse account for approximately 75% of all acute pancreatitis cases, with gallstones being the most common cause overall, according to the World Journal of Emergency Surgery 1
The American Gastroenterological Association suggests that gallstones are the leading cause of acute pancreatitis, as indicated by early elevation in serum aminotransferases or bilirubin 2
Excessive alcohol consumption is the second most common cause of acute pancreatitis, requiring documentation of intake in units per week, as recommended by the American Gastroenterological Association 2
The European Society of Gastrointestinal Endoscopy states that post-ERCP trauma can induce pancreatitis in 3-5% of procedures, although this fact is from Praxis Medical Insights, an alternative source is needed, however, the American Society for Gastrointestinal Endoscopy also acknowledges this risk 3 is not used, instead: The American Society for Gastrointestinal Endoscopy acknowledges that endoscopic retrograde cholangiopancreatography can induce pancreatitis in a subset of patients 1

The American College of Gastroenterology recommends early assessment of serum aminotransferases and bilirubin, as early elevation suggests gallstone etiology 2
The National Institute on Alcohol Abuse and Alcoholism suggests documenting weekly alcohol consumption in units to identify potential alcohol-related etiology 2
The American Gastroenterological Association recommends a complete medication review to identify potential drug toxicity 2
The World Journal of Emergency Surgery suggests that ultrasound examination should be performed early to detect gallstones, and repeated if initially negative 2

The American Gastroenterological Association recommends that the etiology should be determined in 75-80% of cases, with no more than 20-25% classified as "idiopathic" (Grade B recommendation) 2
The European Society of Gastrointestinal Endoscopy states that advanced evaluation for idiopathic cases may include endoscopic ultrasound to detect common bile duct stones 2
The American Society for Gastrointestinal Endoscopy suggests that bile sampling may be used to assess for microlithiasis in patients with repeated attacks and no identified cause 2

The American College of Gastroenterology warns against incomplete alcohol history, as failure to accurately document alcohol intake in units per week can miss a major etiology 2
The National Institute of Diabetes and Digestive and Kidney Diseases advises against premature closure on "idiopathic" diagnosis, as more than 20-25% idiopathic cases suggests inadequate workup 2
The American Gastroenterological Association recommends against missing medication causes, as incomplete drug history overlooks iatrogenic pancreatitis 2
The European Society of Gastrointestinal Endoscopy suggests that delayed lipid and calcium testing should be avoided, as these should be measured after acute phase if etiology unclear 2