pancreatitis could manifest due to a variety of reasons, including infection. Corticosteroids are believed to increase risk of corticosteroids so is the case with many other drugs. You can find many articles on all these from scholar.google search engine.

As a toxicologist, I want to stress here on the role of pesticides in induction of acute pancreatitis. Just have a look at the following, clearly cholinesterase-inhibiting insecticides elicit acute pancreatitis.

http://www.ncbi.nlm.nih.gov/pubmed/18396746

http://www.toxicologyinternational.com/article.asp?issn=0971-6580;year=2012;volume=19;issue=2;spage=223;epage=224;aulast=Goud

http://link.springer.com/article/10.1007%2FBF02425057?LI=true

thank you sir!

although the reason I ask:

41 year old woman diagnosed with type 2 diabetes 6 months earlier, starts to feel sick, stomach ache, vommiting and abdominal swelling, Blood glucose level reading 26 when admitted to hospital. Surgeons open when stable, see that most of pancreas has "died" off, no bacteria detected. 2 days later patient passed away due to multiple system failure. Doctors diagnosis - Pancreatitis. With no explanation as to what may have caused it.

Dear Pretorius,

Sorry to hear that; may her soul rest in peace.

As it seems it was a very serious case of pancreatitis. I am really sorry, I am not competent to make any comments on what could have caused her to develop such serious pancreatitis. I work with rodents, and I have no competence to make any comments regarding what could have caused her pancreatitis. In the case of humans, etiology of any disorder is very complex and is always juxtaposed to complexities of human life (like various diets, alcohol consumption/smoking, exposure to countless varieties of pollutants, stress factors etc). Perhaps, a physician will be able to shed more light on it. I can only talk about what can be considered as general medical knowledge, but a case specific diagnosis can only be given by practicing physicians or surgeons.

Take care

Dear Eugene,

The causes of acute pancreatitis are represented with long list, which is impossible to discuss here. If you look at the literature more than 100 specific causes can be identified. However for western population the most common etiology can be listed as: alcohol, gallstone disease, diet, viruses. These are responsible for >90% of cases. However in clinical practice it is impossible to identify definitely specific cause in all patients. And in patients with fulminant acute pancreatitis leading to multiple organ failure surgery is helpless.

Thank you very much for all the responses.

Nice know people will always try to help!

Regards!

The most common way to remember most of the major causes is with the clever acronym of “GET SMASHED”. The following are the causes which are most common in adults and make up the acronym:

Gallstones - Common problems in the body such as gallstones can cause inflammation of the pancreas. Removal of gallstones can also stun the pancreas and bring it into shock as well as cause it to overwork itself when attempting to recover from the removal.

Ethanol - Consumption of ethanol as well as other types of alcohol make the liver and pancreas overwork. The overproduction of special enzymes from the pancreas can cause it to fail and this is very damaging to the system. Having many alcoholic beverages in a short period of time can cause sudden acute pancreatitis.

Trauma - Damage to the pancreas and surrounding organs can lead to inflammation of the pancreas. This could simply lead to acute pancreatitis as well as further damages which could be life threatening if not treated properly. Damages to the pancreas can cause fluctuations in the enzymes which it produces as well, causing other damages to the body.

Steroids - The use of steroids and other types of hormonal treatments can affect how the pancreas works. One of the most common side effects of all steroids for most people is damage to the pancreas when it attempts to remove excess from the system.

Mumps - The mumps is a common disease spread by children and people of all ages through saliva. The saliva infects others and can cause inflammation of major organs such as the heart, liver and the pancreas. When it affects the pancreas, sudden acute pancreatitis is a result.

Autoimmune - The autoimmune function of the body can be damaged and allow infection to occur within the pancreas. Another possibility is that the autoimmune function targets the organs within the body such as the pancreas which could definitely cause pancreatitis in many individuals with that condition.

Scorpion Sting – A scorpion sting is made of venom which uses many different types of compounds to kill its prey as well as defend itself from predators. One of the most common things that can happen is that the enzyme inhibitors in the venom cause a surge in enzymes to be produced by the pancreas which could lead to damage which causes inflammation, thus sudden acute pancreatitis.

Hypercalcaemia - Most people who consume too much calcium will begin to produce calcium crystals in the blood and organs. When the pancreas is affected with hypercalcaemia, it can easily inflame and cause several different problems, including pancreatitis.

Hypertriglyceridaemia - The large consumption of red meats, foods high in fats such as triglycerides and other unhealthy options such as fast food can cause overworking of the pancreas. This can easily lead to pancreatitis in many people who have a horrible diet or have suddenly made changes to the amount of fatty foods that they eat.

Hypothermia - The gradual or instant cooling of the body to less than 95 degrees Fahrenheit will trigger hypothermia. The presence of this condition almost always causes the body to shut down non-vital extremities and causes vital organs to overwork to keep the core of the body alive. This can cause severe damage to a weak or overworked pancreas way after the body recovers from the condition if they survive it. This can easily lead to pancreatitis.

ERCP - Using the ERCP procedure to dye the pancreas and surrounding organs can cause damage or trauma to the pancreas. This can lead to a sudden burst of acute pancreatitis to occur making it possible to feel any and all symptoms of the condition after the procedure is done within a few weeks time.

Drugs - Negative drug interactions as well as taking prescription drugs which stress the pancreas can easily cause it to fall into an acute pancreatitis episode. Pancreatic function can be impaired or altered within this time frame which is often very dangerous.

http://www.acutepancreatitis.org/

Great response, almost leaving me with more questions than answers, because the person's records will now be impossible to find and it happened 5 years ago, One can only try and settle for the cause.

Questions like: Did she have underlying problems we did not know of, Did the drugs she took cause it, Was it autoimmune...etc..

What baffles me though is that I know the person knew she had diabetes (II) and didnt take her meds as she could not accept the fact that she had diabetes, May that have caused inflammation?

Nonetheless thank you for your time in answering this question.

Your patient suffered six months before her acute pancreatitis of type2 Diabetes. To explain her pancreatits, even if this case occurred five years ago and its personnal record is impossible to find, you may ask:

1/ your lab (which should had the history) if her serum was latescent ( hypertriglyceridemia > 10 g/L, a possible cause), and her ASAT and ALAT values ( predictive of gallstone in women if > 3N)

2/ At evidence, the surgeon did not mentionned "gallstones problems", you may find the final report of this procedure since surgeons and institutions must keep it for at least 20 years, at least in France;

3/ the department of radiology may have computed her results of her abdominal CT scan

4/ pancratitic toxic drug, but she allready did not take her diabetes treament?

Since the most causes in the case of your patient are Gallstones, alcohol, you should focus on them, but i did not think that her diabetes was responsible.

Unfortunately, as allready reported, the surgical procedure may have been harmful: if severe acutepancreatitis should be monitored by a multidisciplinary team (intensvists,surgeon, radiologists,), surgical procedure should be largely discussed after CTscan, and is absolutely necessary in case of gastro-intestinal perforation or massive bleeding.

Unfortunately, few patients with severe acute pancreatitis may die in absence of sepsis, whithin the first week of the pancreatitis, even in absence of surgical procedure

It was published recently that the treatment with Janumet/Januvia is involved in the development of acute pancreatitis as well as pancreatic cancer in diabetic pacients.

why not, but the probabity is very low, since, as reported by E Pretorius, the patient DID not take her drugs. Thus Janumet/Januvia's firms can not be responsible of this cas whic occurred five years ago

There is by far too little data of that sorrowful case to try and clarify the diagnosis. As you wrote it personal interest, so that you may request appropriate papers copy from that hospital where it happened.

I ought to say that when surgeons declare that the pancreas 'died off' there cannot be mistake, it means diffuse and unmistakable pancreonecrosis, and the highest probability of unfortunate outcome. This is quite evident while performing an operation.

About possible cause of the disease:

In 10%–20% of patients, pancreatitis is idiopathic despite careful evaluation of the history and physical exam, routine laboratory tests, transabdominal ultrasound, and CT [Textbook of Gastroenterology, 5th ed., 2010, p.1781].

The diabetus mellitus type II itself could hardly cause the heavy acute pancreatitis, but it could worsen a clinical course and outcome of that ilness (depending of the serum glucose level, etc.).

However, if the diabetis was mild, the hyperglycemia you noticed (26 mmol/L, right?), most probably was just a sequense, not the cause, of the acute pancreatitis and pancreatogenic shock themselves. It is one of the common signs of the pancreatitis heaviness (one of so-called 'Ranson criteria').

In general, the main etiology for the acute necrotizing pancreatitis to develop in 41-year-old lady is gallstone disease. See:

[Appelros S, Borgstrom A. / Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden // Br J Surg 1999;86:465;

Jaakkola M, Nordback I. / Pancreatitis in Finland between 1970 and 1989 // Gut 1993;34:1255

Thomson SR, Hendry WS, McFarlane GA, Davidson AI. / Epidemiology and outcome of acute pancreatitis // Br J Surg 1987;74:398].

Of importance, the gallstone disease may not only exist in form of macro-, but microlithiasis also. The latter is even more dangerous in this context.

For example, see:

[Ardengh JC, Malheiros CA, Rahal F, Pereira V, Ganc AJ. / Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis // Rev Assoc Med Bras. 2010 Jan-Feb;56(1):27-31

Ros E, Navarro S, Bru C, et al. / Occult microlithiasis in “idiopathic” acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy // Gastroenterology 1991;101:1701

Lee S, Nicholls J, Park H. / Biliary sludge as a cause of acute pancreatitis // N Engl J Med 1992;326:589.

Dahan P, Andant C, Levy P, et al. / Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography // Gut 1996;38:277]

As an alternative etiology, I might say of the scorpion sting [ Possani L, Martin B, Fletcher M, Fletcher P. / Discharge effect on pancreatic exocrine secretion produced by toxins purified from Tityus serrulatus scorpion venom // J Biol Chem 191;266:3178] and bites of venomous snakes, but the latter usually give umambiguous history...

Here is one more full-text article on hereditary acute pancreatitis in adults from Annals of Surgery:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242368/pdf/annsurg00083-0061.pdf