How we predict the etiology of acute pancreatitis

Although acute pancreatitis (AP) may be the consequence of numerous etiologic factors, more than 80% of the episodes are of biliary or alcoholic origin. Although the clinical picture is similar irrespective of the etiology, patients with severe episodes of acute pancreatitis require specific therapeutic maneuvers when biliary-induced while, in the case of alcoholic origin, they only need general support. As a consequence, the early estimation of the etiology is of particular interest, and older age and female sex are frequent characteristics of AP of biliary origin. Together with these factors, abnormal liver function tests have been classically used to identify biliary etiology. Their intrinsic value has grown in the era of new imaging techniques. From another perspective, the plasmatic level of carbohydrate-deficient transferrin seems to be the most accurate technique in differentiating cases of alcohol-induced acute pancreatitis from other etiologies.