Serine peptidase inhibitor Kazal-type 1 (SPINK1) is secreted by pancreatic acinar cells and functions as a trypsin inhibitor.

It impedes the activity of trypsinogen molecules that become prematurely activated within the pancreas.

Trypsin itself can serve as inhibitor of premature trypsinogen activation (before it reaches the duodenal lumen)

Hereditary pancreatitis

a rare disorder that results from mutations involving the trypsinogen or SPINK1 gene.

The most common mutation leads to the production of abnormal trypsin that is not susceptible to inactivating cleavage by trypsin.

Drug-induced Pancreatitis

1- HIV patient ===>pentamidine or didanosine

2- HTN patient ===> Thiazide diuretics or furosemide

3- IBD patient ===> sulfasalzine

4- Immunosuppressed ===> azathioprine

5- Bipolar patient or seizure disorder ===> valproate

6- Antibiotics ===> Metronidazole or tetracyclines

mnemonics: AIDS w/ HIV. A= ABx, I - immunosuppressant, Diuretics, Seizure drug, HIV drugs

Chronic Pancreatitis

Abd X-ray - 50% to 60% sensitive for calcifications but quite specific if abnormality is there

ABd CT scan - 80% to 90% sensitive

ERCP