Gallstone Pancreatitis: Causes, Symptoms, and Treatments

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 forms 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 leads 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 be removed to repair the gallstone pancreatitis condition.

Symptoms

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, eyes, or both (jaundice).
• Vomiting and nausea
• Severe, radiating pain that travels to the back, shoulder, and chest from the upper abdomen

Causes

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

The common bile duct connects the gallbladder and the pancreas. In normal people, bile travels the gallbladder through the common bile duct en route to the small intestine. However, 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 back-washing 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.

Diagnosis

If you arrive at the hospital with typical symptoms, your healthcare provider will perform a blood test to check pancreatic enzyme levels and assess liver enzymes to determine liver involvement. They will also use imaging tests to evaluate the severity of pancreatitis.

An abdominal ultrasound can detect gallstones in the ducts, while a CT scan provides a more detailed view of the pancreas if needed. In some cases, the gallstone that initially caused the blockage may have already passed by the time you seek treatment. However, if other gallstones are present, doctors can confirm that they triggered the condition.

Treatment Options

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

Supportive care includes: 

• IV fluids should be administered to address possible dehydration and rebuild blood volume.
• Pain management through injection or oral medications.
• Allowing the bowel to rest. This means not eating normally until the pancreas is stable. Sometimes, nutrition is provided through a nasogastric tube or by increasing 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 can be used to drain urine and measure 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 thoroughly examines the bile duct. This procedure is supported by fluoroscopic X-ray technology. A skilled doctor assesses the condition of the bile duct using a combination of tubes and a lighted camera inserted through the throat into the stomach. Eventually, they insert tools through the tubes to 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 to remove 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 pain after eating. It may be accompanied by 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 the patient experiences this symptom, discussing it with a doctor and reviewing the condition is best. Otherwise, it may turn into a more serious situation.

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

Recognizing the Warning Signs Matters

Most people rarely think about their gallbladder and may not realize they have gallstones. As a result, gallstone pancreatitis often begins with a sudden and severe flare-up of an underlying condition. The sharp pain that develops can be intense and unexpected.

To prevent delayed detection, it’s crucial not to ignore recurring upper abdominal pain, especially after eating. This pain may indicate biliary colic, an early warning sign of gallstone-related issues. Instead of hoping it will go away, seek medical attention immediately.

Early diagnosis notably improves the effectiveness of treatment for gallstone pancreatitis.

Frequently Asked Questions