Gallstone Pancreatitis: Symptoms & Treatment

Gallstone pancreatitis: Symptoms and treatment

When a gallstone blocks a patient’s pancreatic duct, the blockage causes a condition called gallstone pancreatitis. Symptoms like intense pain, inflammation, nausea and vomiting appear. This is because the digestive juices are backing up and are causing damage to the pancreas. This is a life-threatening condition. 

What is gallstone pancreatitis?

The gallbladder stores bile made by the liver. When the gallbladder does not function properly, when it does not empty itself completely or not as often as it must, the residual bile sludge form gallstones. In other words, gallstones are formed in the gallbladder from crystallized bile concentrations. When a gallstone blocks the pancreatic duct, it causes gallstone pancreatitis or biliary pancreatitis. The blockage of the pancreatic duct lead to the backing up of the pancreatic enzymes in the pancreas. This, in turn, leads to irritation, pain and inflammation. The gallstone has to either pass through the duct or it has to be removed to repair the gallstone pancreatitis condition. 

Symptoms of gallstone pancreatitis

A sharp, shooting pain in the epigastric region, which is the upper part of the abdomen, is the most common symptom of gallstone pancreatitis. This is accompanied by a few more symptoms that a medical practitioner may identify:

• Loss of appetite.
• A yellow tinge to the skin or eyes or to both (jaundice).
• Vomiting and nausea.
• Severe, radiating pain that travels to the back, shoulder and chest from the upper abdomen.

Causes of gallstone pancreatitis

Gallstones are not caused by a single factor. They form in patients for various reasons, each one being unique to a patient’s medical history. Some patients have excess cholestrol in their blood, either due to their diet or because their bodies have a metabolic disorder. This excess cholestrol can accumulate in the bile. In patients with liver disease, excess bilirubin in their blood and bile may be present. These excess amounts of cholestrol or bilirubin forms a sludge at the bottom of the gallbladder. Typically, the gallbladder must empty itself routinely and completely. But a malfunction can cause this emptying process to fail in some patients. High estrogen levels too can lead to the gallbladder being unable to empty itself completely. Pregnant women are therefore at higher risk of this condition. 

The gallbladder and pancreas are connected by the common bile duct. In normal people, bile travels the gallbladder through the common bile duct en route to the small intestine. But in people who have gallstones, one or more of the gallstones could also pass through the common bile duct over time. 

As more and more bile washes over a small gallstone, it grows. The gallstone then gets stuck in one place – either in the pancreatic duct or just outside it. 

The blockage by a gallstone can lead to pancreatitis in one of two ways. 

1. When the gallstone blocks the common bile duct outside the pancreatic duct, it leads to bile backwashing into the pancreas. Bile is very corrosive and irritates the pancreas.    Most people with emphysema are smokers. In an overwhelmingly large percentage of cases, cigarette smoking has been found to be the primary cause for emphysema and COPD.
2. A blockage in the pancreatic duct leads to pressure building up in the duct and the pancreas. This pressure triggers the pancreatic enzymes. These enzymes are also highly corrosive. They irritate the pancreas when they back up into it. 

In either scenario, gallstones cause acute pancreatitis. The symptoms of the condition quickly manifest. And the patient must be immediately rushed to a hospital. 

Treatment options

Patients with severe symptoms are immediately admitted to intensive care. Most other patients receive well-planned, supportive care. 

Supportive care includes: 

• Administering of IV fluids to address possible dehydration and rebuild blood volume.
• Pain management through injection or oral medications.
• Allowing for the bowel to rest. This means not eating normally until the pancreas is stable. In some cases, nutrition is provided through a nasogastric tube or by increase glucose content in the IV fluids. 
• Medication to deal with nausea and vomiting.
• Oxygen support if there is a need.
• Antibiotics to fight possible infections.
• A urinary catheter to drain urine and also to measure the urine output.

If the patient is in intensive care, it is usually apparent that a surgical intervention is unavoidable.  The team handling the patient may choose one of these procedures:

• ERCP: This is endoscopic retrograde cholangiopancreatography. Using X-rays and an endoscope, the ERCP test conducts a detailed examination of the bile duct. This procedure is supported by fluoroscopic X-ray technology. Using a combination of tubes, with a lighted camera, inserted through the throat into the stomach, a skilled doctor assess the condition in the bile duct. Eventually, they insert tools through the tubes to deftly remove the gallstones and place stents to relieve the blockages in the area.
• Gallbladder removal: Removing the gallbladder is a safe and efficient treatment plan. When a medical practitioner assesses the gallstone pancreatitis condition, they will consider if it can recur. If they conclude that the patient is at high risk because of the possibility of recurrence of the condition, they will recommend the removal of the gallbladder. In most cases laparoscopic cholecystectomy is performed. This is done by making a few incisions. Using a laparoscope, a miniature camera is inserted through one of the incisions. Working with the aid of the camera, the doctor removes the gallbladder. In some cases, a conventional open surgery may be performed for removing the gallbladder. 

Prevention and management

The gallbladder is located below the right rib cage, on the upper side of the abdomen. A pain in that area is an early warning sign. The patient may experience this pain after eating. It may be accompanied with nausea. This pain is called biliary colic. When biliary colic keeps recurring it points to a partial or occasional blockage in the bile ducts or the gallbladder. As the gallbladder contracts and relaxes, the pain may come and go. When this symptom is experienced by the patient, it is best to consult a doctor and review the condition. Else it may turn into a more serious situation. 

When a laparoscopic procedure is undertaken to remove the gallbladder, a patient is advised care and treatment for two weeks after the procedure. In the case of an open surgery, the recovery time usually takes up to eight weeks. 

Conclusion

Most people don’t think of their gallbladder. And therefore they don’t know they have gallstones. So, usually, gallstone pancreatitis is marked by a sudden aggravation of a condition that’s perhaps been around for a while. The pain that sets in is sharp and severe. It takes the patient by surprise. 

In order to avoid late detection of gallstone pancreatitis, it is important not to ignore upper abdominal pain that comes and goes. Especially if the pain appears after eating. This is a clear warning sign of biliary colic. Don’t ignore this pain or wish that it would go away. Please see your doctor immediately. 

The administration of any treatment plan for gallstone pancreatitis will work better when the condition is identified early. 

Frequently Asked Questions

1.What is gallstone pancreatitis?

When a gallstone blocks a patient’s pancreatic duct, the blockage causes a condition called gallstone pancreatitis.

2.What are the symptoms of gallstone pancreatitis?

A sharp, shooting pain in the epigastric region, which is the upper part of the abdomen, is the most common symptom of gallstone pancreatitis. Other symptoms include loss of appetite, vomiting and nausea, radiating pain that travels from the upper abdomen to the back, shoulder and chest, and a jaundiced look in the eyes and on the skin. 

3.What causes gallstone pancreatitis?

Gallstones are not caused by a single factor. They form in patients for various reasons, each one being unique to a patient’s medical history. Gallstones cause acute pancreatitis when the block the common bile duct or the pancreatic duct. The symptoms of the condition quickly manifest. And the patient must be immediately rushed to a hospital. 

4.What are the treatment options?

Endoscopic retrograde cholangiopancreatography is done to remove gallstones and stents are placed to relieve blockages. Or laparoscopic cholecystectomy is performed to remove the gallbladder in most cases. In some cases, an open surgery is performed to remove the gallbladder. 

5.How can gallstone pancreatitis be prevented?

In order to avoid late detection of gallstone pancreatitis, it is important not to ignore upper abdominal pain that comes and goes. Especially if the pain appears after eating. This is a clear warning sign of gallstone pancreatitis. Don’t ignore this pain or wish that it would go away. Please see your doctor immediately.