<prompt> Which of the investigation can itself lead to acute pancreatitis: March 2008USGCT scanERCPMRI scan  <response>: Ans. C: ERCP Causes of acute pancreatitis I GET SMASHED: I - idiopathic. G - gallstone. Gallstones that travel down the common bile duct and which subsequently get stuck in the Ampulla of Vater can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum. The backflow of these digestive juices causes lysis dissolving of pancreatic cells and subsequent pancreatitis. E - ethanol alcohol T - trauma S - steroids M - mumps paramyxovirus and other viruses Epstein-Barr virus, Cytomegalovirus A - autoimmune disease Polyaeritis nodosa, Systemic lupus erythematosus S - scorpion sting e.g. Tityus trinitatis, and also snake bites H - hypercalcemia, hyperlipidemiahyperiglyceridemia and hypothermia E - ERCP Endoscopic Retrograde Cholangio-Pancreatography D - drugs SAND - steroids and sulfonamides, azathioprine, NSAIDS, diuretics such as furosemide and thiazides, and didanosine and duodenal ulcers. This mnemonic is also roughly arranged according to the frequency of its causes. Thus: Gallstone pancreatitis is more common than pancreatitis caused by alcohol, trauma, or steroids. Signs which are less common, and indicate severe disease, include: Grey-Turners sign hemorrhagic discoloration of the flanks Cullens sign hemorrhagic discoloration of the umbilicus 