Dr. Christopher Carrubba and Dr. Brian Radvansky contributed to this article.
If you clicked on this post title hoping for advice on how to party your way through medical school, our apologies. Oftentimes when on internal medicine rounds, attendings will go for the low-hanging fruit of differentials:
What are the causes of pancreatitis? So while everyone can somehow remember scorpion stings as a potential etiology, we’re here to help you knock out a few more causes and set you up to impress that ever so intimidating attending.
Mnemonic: I GET SMASHED
Usage: Remembering the causes of acute pancreatitis
For this mnemonic, each letter corresponds to a particular cause. Let’s break it down below:
I = idiopathic (also known as the fancy medical way of saying, “I dunno.”)
G = gallstones (one of the two most common causes of acute pancreatitis)
E = EtOH (the other common cause of acute pancreatitis)
T = trauma
S = steroids
M = mumps/malignancy
A = autoimmune
S = scorpion stings … though this probably shouldn’t be your first guess for why your patient has pancreatitis
H = hypertriglyceridemia/hypercalcemia
E = (post) ERCP
D = drugs. Most commonly: thiazides, sulfa drugs, and didanosine
Gallstones and Alcohol: The Most Common Causes of Pancreatitis
While appearing brilliant on rounds is one thing, eventually you will want to be able to channel your differentials into what’s most useful, and what’s just fluff to impress those around you.
If pancreatitis were a band, its first album would be called “Gallstones and Alcohol.” As mentioned above, these are your two most common etiologies, so always consider them if you are considering pancreatitis as a diagnosis.
Trauma and Pancreatitis
Trauma is another one to consider in the setting of … a trauma. If you smash any vital organ with a steering wheel or baseball bat, cells will die, and spill their contents into your patient’s bloodstream.
Mumps and Pancreatitis
We aren’t seeing much mumps in the ward these days…
Autoimmune pancreatitis only accounts for ~5% of cases, so only in 1 out of your 20 patients will have their own immune system to blame.
Scorpions?! Enough said.
Hypertriglyceridemia and Hypercalcemia
Hypertriglyceridemia/hypercalcemia are likely to be caused by some familial error of metabolism. This would likely be diagnosed early in life.
Post-ERCP and Pancreatitis
Post-ERCP is a pretty obvious one. If you go instrumenting around the pancreas and slicing open the sphincter of Oddi, you’ve got a 5-10% chance of developing pancreatitis.
Drug Reactions and Pancreatitis
And drugs - they can affect just about any body system. So keep them in mind for inflammation/dysfunction of any organ. If ever asked for the cause of a physiologic perturbance or vital sign change, offering “drug reaction” as a possible cause will hardly ever be wrong.
So there you have it… A way to get smashed in medical school AND look smarter in the process!