Mastering USMLE Mnemonics: I Get Smashed…and Then Get Pancreatitis

  • /Reviewed by: Amy Rontal, MD
  • Dr. Christopher CarrubbaDr. Brian Radvansky, and Dr. Taylor Purvis contributed to this article.

    If you clicked on this post title hoping for advice on how to party your way through medical school, our apologies. Oftentimes when on internal medicine rounds, attendings will go for the low-hanging fruit of differentials:

    What are the causes of pancreatitis? So while everyone can somehow remember scorpion stings as a potential etiology, we’re here to help you knock out a few more causes and set you up to impress that ever so intimidating attending.

    Mnemonic: I GET SMASHED

    Usage: Remembering the causes of acute pancreatitis

    For this mnemonic, each letter corresponds to a particular cause:

    I = idiopathic

    This cause of pancreatitis is an unknown one, so treatment proves to be more challenging. Regardless, it’s best to proceed with supportive management.

    G = gallstones

    Gallstones originate from bile and if the bile flow is slowed or stopped, then it precipitates and creates gallstones, which could be one of the three: cholesterol stones, black pigment stones, or mixed stones. When a stone blocks an area, the pressure increases in the surrounding tissue, which causes interstitial oedema,  impaired blood flow, ischaemia, acinar cell injury, enzyme activation, and lastly, auto-digestion.

    E = EtOH

    Alcohol can damage the pancreas when consumed in excess in one of three ways. Chronic alcohol causes blockage leading to auto-digestion, it causes acinar cell injury by releasing intracellular proenzymes and lysosomal hydrolase, then activation of enzymes, also leading to auto-digestion, or it causes defective intracellular transport and excess alcohol creates toxic substances like free radicals that can damage pancreas cells.

    T = trauma

    The pancreas is very prone to trauma. If any force is applied to the soft organ, it can rupture its build and spill its content causing cells to die from the force, or blood vessels may rupture.

    S = steroids

    Recent or increased steroid use may induce pancreatitis long term. However, this is rare and other potential causes should be considered before this one.

    M = mumps/malignancy

    Mumps may result in short-term inflammation of the pancreas, but is more common in unvaccinated children as a complication. 

    A = autoimmune

    The immune system attacks and breaks down the pancreas, leading to enzymes leaking to its surroundings and causing inflammation. 

    S = scorpion stings

    The venom being released from a scorpion irritates the pancreas causing inflammation and swelling. 

    H = hypertriglyceridemia/hypercalcemia

    A high amount of triglycerides and calcium in the blood damages the pancreas. The lipase enzyme breaks down the triglyceride and causes a toxic amount of fatty acids. Hypercalcemia refers to high serum calcium levels. This calcium range has been shown to cause pancreatitis. It is crucial to identify the issue and treat the cause.

    E = (post) ERCP

    The endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique that combines endoscopy and fluoroscopy to diagnose or treat specific problems within the biliary or pancreatic ductal system. A low volume of ERCP procedures end up with pancreatitis issues.

    D = drugs

    Drugs such as Azathioprine, NSAIDs, or diuretics  can cause pancreatitis. There is low risk associated with their usage; however, risk increases with more than one are used at one time.

    Sources:

    https://www.andreasastier.com/blog/i-get-smashed-mnemonic-pancreatitis-causes-and-management