From the Guidelines
Pancreatitis in the tail of the pancreas is most commonly caused by gallstones, as they can obstruct the pancreatic duct and lead to inflammation, as noted in the management guidelines for acute pancreatitis 1. The causes of pancreatitis in the tail of the pancreas can be multifactorial, including:
- Gallstones, which can obstruct the pancreatic duct and lead to inflammation when digestive enzymes become trapped in the pancreas
- Alcohol abuse, which damages pancreatic cells directly and alters metabolism of pancreatic enzymes
- Hypertriglyceridemia, which can trigger inflammation through free fatty acid release
- Certain medications, such as azathioprine, 6-mercaptopurine, sulfonamides, tetracyclines, and valproic acid, which can induce pancreatitis as a side effect
- Autoimmune conditions, where the immune system mistakenly attacks pancreatic tissue
- Trauma, pancreatic tumors, ERCP procedures, infections, and genetic factors like mutations in the PRSS1, SPINK1, or CFTR genes, which can also contribute to the development of pancreatitis in the tail of the pancreas. It is essential to conduct a thorough aetiological assessment, including clinical features and tailored to the patient's background and age, to determine the underlying cause of pancreatitis, as the aetiology will affect decision making and further therapeutic options 1. Diagnosis typically requires imaging studies like CT scans or MRI, along with blood tests for pancreatic enzymes, and it is crucial to exclude other life-threatening conditions, such as mesenteric ischaemia, visceral perforation, or leaking abdominal aortic aneurysm 1.
From the FDA Drug Label
PANCREATITIS CASES OF LIFE-THREATENING PANCREATITIS HAVE BEEN REPORTED IN BOTH CHILDREN AND ADULTS RECEIVING VALPROATE SOME OF THE CASES HAVE BEEN DESCRIBED AS HEMORRHAGIC WITH A RAPID PROGRESSION FROM INITIAL SYMPTOMS TO DEATH.
222 Pancreatitis Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate. Some of the cases have been described as hemorrhagic with rapid progression from initial symptoms to death.
The causes of pancreatitis in the tail of the pancreas are not explicitly stated in the provided drug labels. However, the labels do mention that valproate can cause pancreatitis, which can be life-threatening and may occur in both children and adults.
- The exact causes of pancreatitis in the tail of the pancreas are not specified.
- Valproate is associated with an increased risk of pancreatitis.
- Patients and guardians should be warned that abdominal pain, nausea, vomiting, and/or anorexia can be symptoms of pancreatitis that require prompt medical evaluation 2, 2.
From the Research
Causes of Pancreatitis in the Tail of the Pancreas
The causes of pancreatitis in the tail of the pancreas are not specifically addressed in the provided studies. However, the studies do discuss the general causes of pancreatitis, which may be relevant.
- Common causes of pancreatitis include:
- Drug-induced pancreatitis is a rare but possible cause, with various medications implicated, including:
- It is essential to note that the provided studies do not specifically discuss the causes of pancreatitis in the tail of the pancreas, but rather the general causes of pancreatitis.
Drug-Induced Pancreatitis
Drug-induced pancreatitis is a rare but possible cause of pancreatitis, and it is essential to consider this diagnosis in patients presenting with unexplained pancreatitis, especially those on multiple medications.
- A high index of suspicion is necessary to diagnose drug-induced pancreatitis, particularly in specific subpopulations such as geriatric patients, HIV+ patients, cancer patients, and patients receiving immunomodulating agents 5.
- Discontinuation of the offending medication can result in symptom resolution, as seen in the case report of a patient with recurrent acute pancreatitis associated with hydrochlorothiazide use 7.