A 45-year-old female presents with acute severe epigastric pain that radiates through to her mid-back, accompanied by persistent retching and vomiting. Serum amylase is 980 U/L and serum lipase is 1,450 U/L (more than three times the upper reference limit). Abdominal ultrasound reveals gallstones in the gallbladder without common bile duct dilation. What is the most common etiology of acute pancreatitis in non-alcoholic adult patients?

Answer and explanation

Correct answer: C. Gallstone disease (Biliary pancreatitis)

  1. Step 1: Gallstones (biliary pancreatitis) and alcohol abuse account for over 70% to 80% of all acute pancreatitis cases in adults.
  2. Step 2: In non-alcoholic patients, gallstones are the single most common cause, triggering transient or sustained obstruction of the ampulla of Vater.
Answer
Gallstone disease (Biliary pancreatitis).
Why not the others: 'Cigarette smoking' is a major risk factor for chronic pancreatitis and pancreatic adenocarcinoma, not acute pancreatitis; 'Hypertriglyceridemia' causes acute pancreatitis only when levels exceed 11.3 mmol/L (1000 mg/dL), accounting for ~5% of cases; 'Autoimmune IgG4 pancreatitis' causes chronic sclerosing pancreatitis.

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