Three factors cause premature enzyme activation. Mechanical causes—such as pancreatic duct damage and obstruction—may result from gallstones migrating into the duct, bile reflux from the duodenum into the duct, tumors, radiation therapy, ulcer disease, or inflammation. Metabolic causes result from changes in the secretory processes of the acinar cells in conditions such as alcoholism (90% of the cases), diabetic ketoacidosis, hyperlipidemia, hypercalcemia, and drugs (acetaminophen, estrogen). Miscellaneous causes include infectious diseases (mumps, hepatitis B, coxsackie viral infections) and ischemic injury as a result of lupus erythematosus, cardiopulmonary bypass surgery, post-transplantation complications, or shock.

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