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Table 154-3

Chronic Pancreatitis and Pancreatic Exocrine Insufficiency: TIGAR-O Classification System

Toxic-Metabolic
Alcoholic
Tobacco smoking
Hypercalcemia
Hyperlipidemia
Chronic renal failure
Medications-phenacetin abuse
Toxins-organotin compounds (e.g., dibutylin dichloride, DBTC)
Idiopathic
Early onset
Late onset
Tropical
Genetic
Cationic trypsinogen (PRSS1)
Cystic fibrosis transmembrane conductance regulator gene (CFTR)
Calcium-sensing receptor (CASR)
Chymotrypsin C gene (CTRC)
Pancreatic secretory trypsin inhibitor gene (SPINK1)
Autoimmune
Type 1 autoimmune chronic pancreatitis
IgG4 systemic
Type 2 autoimmune chronic pancreatitis
Recurrent and Severe Acute Pancreatitis
Postnecrotic (severe acute pancreatitis)
Recurrent acute pancreatitis
Vascular diseases/ischemia
Radiation induced
Obstructive
Pancreas divisum
Duct obstruction (e.g., tumor)
Preampullary duodenal wall cysts
Posttraumatic pancreatic duct scars

Abbreviations: DBTC, dibutylin dichloride; TIGAR-O, toxic-metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, obstructive.