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Official websites use. Share sensitive information only on official, secure websites. Email: drgauravnepal gmail. The definition for acute pancreatitis AP was first proposed by the Atlanta classification system in Subsequently, a more revised classification system to allow for a consistent worldwide classification using definitive imaging criteria was established in The revised Atlanta classification requires that two or more of the following criteria be met for the diagnosis of acute pancreatitis: a abdominal pain suggestive of pancreatitis, b serum amylase or lipase level greater than three times the upper normal value, or c characteristic imaging findings. Since the implementation of this criteria, the diagnosis of AP has been streamlined and has led to earlier diagnosis and institution of management which is vital during the initial 24—48 hours of manifestation. The diagnosis and management of AP is pivotal since it is the leading cause of gastrointestinal related hospitalization in the United states. It is unclear if this is attributed to a true increase in the number of cases or increased detection of cases of AP. Recently in the United States, the population incidence has been cited as — per , people and approximately ,—, hospital discharges per year from AP. However, it is important to establish the etiology of pancreatitis to prevent recurrent episodes that ultimately predispose patients the risk of developing chronic pancreatitis and pancreatic cancer. She stated that the pain was worse after eating meals, and she took ibuprofen mg once and several doses of bismuth subsalicylate liquid with no relief. She denied any alcohol use, but endorsed a smoking history and cannabis use for the past 20 years. On arrival, she was afebrile, not tachycardic, and saturating well on room air. The abdominal examination revealed a soft, nondistended abdomen with epigastric and left upper quadrant palpable tenderness. Further imaging modalities such as chest radiography, abdominal ultrasound US , and computed tomography of abdomen and pelvis CTAP with contrast were performed. The abdominal US showed a homogenous liver and no evidence of gallstones or gallbladder wall thickening, and no renal abnormalities. The CTAP with contrast showed minimal stranding adjacent to the mid duodenum and pancreatic head suggesting pancreatitis Figure 1. Per Revised Atlanta classification, the patient made all three criteria so was diagnosed with AP. Axial View. During the hospitalization, the patient received one liter intravenous IV bolus of 0. She was also given two doses of IV famotidine 20 mg with improvement and slowly being able to tolerate diet. The patient was subsequently discharged after counseling regarding cessation of smoking tobacco and cannabis products. Cannabis is increasingly becoming one of the most commonly used recreational substances and according to a survey by WHO, its use in the United States US and New Zealand are higher than other countries. Cannabis induced pancreatitis is a rare cause of AP and the diagnosis is difficult because a clear diagnostic criteria is lacking. Cannabis was first reported as a possible cause of AP in and since then only 26 total cases have been reported. A systematic review by Barkin et al in describes a temporal relationship between the use of cannabis and recurrent pancreatitis in 15 of these 26 cases. Furthermore, the study showed that there were 13 reports of no further pancreatitis episodes after cannabis cessation. In order to better understand the association between cannabis use and AP, a more detailed analysis of the underlying pathogenesis is important and required. Currently, it is known that cannabis acts via two cannabinoid receptors CB I and CB II, which are both extensively prevalent in pancreatic tissue. It is thought that this interaction creates a physiological milieu similar to that which is noted in AP. Some other studies have also hypothesized that the activation of the CB I receptor leads to an impaired relaxation of the sphincter of oddi, which can further act as an acute trigger for CIP. These cannabinoid receptors have also been noted to decrease gastric acid secretions, intestinal secretions, and delay gastric emptying. Some suggest that the activation of CB1 receptors leads to a decrease in insulin secretion. It is postulated that continued and prolonged use of cannabis will eventually lead to a compounding effect in the body triggering CIP in patients. As there can also be several other possible triggers to potentiate AP, establishing a strong causal link between cannabis use and AP is difficult. Cannabis is quickly becoming one of the most popular recreational drugs. However, a thorough history and identifying risk factors becomes pivotal in preventing recurrences and can potentially curb the incidence of chronic pancreatitis and pancreatic cancer. DS, HG, SJ, and JR wrote the initial draft of the manuscript; GN, JL, DS and VJ edited the draft and reshaped it into this manuscript; all authors have approved the final version of the manuscript and agreed to be accountable for all aspect of the work in ensuring that question related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Delayed presentation of cannabis induced pancreatitis. Clin Case Rep. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Find articles by David Song. Find articles by Harinivaas Shanmugavel Geetha. 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