Cholelithiasis comes right at the top of our list, and we ll talk a lot about that in a minute. Hereditary pancreatis is not going to be the subject of my talk, but clearly, taking a careful family history is important. Anomalies of the pancreas are listed here. I put Now when you evaluate a patient for recurrent acute pancreatitis, the history is very important. Not infrequently people get labeled as having pancreatitis because they have an attack of pain, the amylase is elevated.
Nobody checks the amylase later and finds that it is still just as elevated.
And since macroamylasemia affects a couple of percent of the population, this is an important consideration. Be it alcoholic pancreatitis, which is pretty simple to elicit, or whether these are truly attacks of idiopathic recurrent pancreatitis. Because if you can demonstrate chronicity it removes the issue of, let s say, gallstones and removing the gallbladder from the picture. So the implications are obvious. I think nearly all of us know that, and perhaps we should just look back at the historical papers which allow us to say that.