I admitted a lady this afternoon with a third episode of pancreatitis within the last twelve months. She neither drinks, nor has any gallstones apparent on abdominal ultrasound (which together account for 90% of cases of acute pancreatitis in the UK). She also lacks the remaining rare but recognized risk factors for pancreatitis: trauma, Cocksackie/Mumps infection, scorpion bites, steroids, hypercalcaemia, etc.
The patient has a twenty pack-year history of smoking, and a background of Ischaemic Heart Disease, Hypertension, and Type 2 Diabetes Mellitus. Her list of regular medications includes Simvastatin, Bendroflumethiazide, and Enalapril. Tucked away in the fine print of side effects associated with all three of these drugs, is pancreatitis.
So the suspected culprits have been stopped and will shortly be reviewed. Interestingly, while writing her drug chart from the list of her regular medications on EMIS, I noted she was not currently on either Aspirin or Clopidogrel - rather odd for a person boasting every risk factor under the sun for atherosclerotic disease. A search of the patient's notes revealed a previous gastritis in association with Aspirin. And Clopidogrel?
Causes pancreatitis.
