Gallstone Pancreatitis: Causes, Diagnosis and Treatment

Gallstone pancreatitis occurs when a gallstone (hardened deposits that form in the gallbladder) gets stuck in the common bile duct (the tube that carries digestive enzymes from the pancreas and bile from the liver and gallbladder into the small intestine). Pancreas produces enzymes to help with digestion and hormones to regulate blood sugar; when a gallstone obstructs the flow of these enzymes, it can cause irritation, inflammation, and swelling of the pancreas, leading to gallstone pancreatitis. In this article, we present a comprehensive overview of gallstone pancreatitis, including its causes, diagnosis and treatment. Read on.

Gallstone Pancreatitis Causes and Risk Factors

While factors such as alcohol consumption and certain medications can contribute to pancreatitis, it’s important to note that gallstones are typically the primary underlying cause of gallstone pancreatitis.

Gallstone Pancreatitis Risk Factors

The risk factors for gallstone pancreatitis include:

• Age and Gender: It’s more prevalent in individuals over 40, and women are at a higher risk compared to men.
• Obesity: Excess body weight increases the likelihood of gallstone formation.
• Rapid Weight Loss: Losing weight too quickly, whether through diet or surgery, can promote gallstone development.
• Genetics: Family history can play a role, as genetics may influence the likelihood of gallstone formation.
• Dietary Factors: A high-fat or high-cholesterol diet can contribute to gallstone formation.
• Pregnancy: Being pregnant can increase the risk due to hormonal changes and pressure on the gallbladder.

Gallstone Pancreatitis Signs and Symptoms

Pancreatitis is a medical condition that can be accompanied by a range of symptoms. These symptoms can be categorised into two main groups:

Common Symptoms

• Severe Abdominal Pain: People with pancreatitis often have very strong belly pain, usually on the upper left side, where the pancreas is. This pain can feel sharp and squeeze-like and may also spread to the chest, shoulder, or back.
• Nausea and Vomiting: Another prevalent symptom is persistent nausea, often leading to vomiting.

Advanced Symptoms

As pancreatitis progresses or becomes more severe, additional symptoms may become evident. These can include:

• Swollen Abdomen: The abdomen may visibly swell due to inflammation and fluid accumulation.
• Increased Heart Rate: The heart rate may increase as the body responds to inflammation and pain.
• Fast Breathing or Shortness of Breath: Individuals with pancreatitis may experience rapid breathing or breathlessness.
• Body Temperature: Some patients might exhibit a lower-than-average body temperature, which can indicate complications.
• Fever and Chills: Fever and chills may occur, indicating an inflammatory response in the body.
• Jaundice: Yellowing of the skin and eyes, known as jaundice, can occur when pancreatitis affects the bile duct.

Gallstone Pancreatitis Diagnosis

Diagnosing gallstone pancreatitis involves clinical assessment, laboratory tests, and imaging studies. It is recommended to seek medical consultation with one of the best gastroenterologists in India.

Laboratory Tests

Several key laboratory tests aid in diagnosing gallstone pancreatitis:

• Amylase and Lipase: Elevated levels of these pancreatic enzymes in the blood indicate pancreatitis.
• Liver Function Tests: Elevated liver enzymes can suggest a blockage in the common bile duct.
• Complete Blood Count (CBC): An increased white blood cell count in the CBC may indicate inflammation or infection.

Imaging Studies

Imaging studies provide valuable insights into gallstone pancreatitis:

• Abdominal Ultrasound: The initial imaging test often identifies gallstones and assesses the gallbladder for signs of inflammation.
• CT scan: This diagnostic tool offers detailed images of the pancreas and helps determine the extent of inflammation while identifying complications such as pseudocysts or necrosis.
• Magnetic Resonance Cholangiopancreatography (MRCP): A specialised MRI that visualises the bile and pancreatic ducts, making it especially useful for detecting small stones or sludge obstructing them.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This is a dual-purpose diagnostic and therapeutic procedure. An endoscope equipped with a camera is passed down the throat, through the stomach, and into the small intestine. Dye is injected into the pancreatic ducts and bile, and X-rays are taken. If gallstones are found in the common bile duct, they can often be removed during the procedure.

Gallstone Pancreatitis Treatment

There is no specific medicine to treat pancreatitis. Treatment begins with a hospital stay to manage complications and symptoms. These include:

• Pain Medicines: The healthcare team provides patients with medications to help control the pain caused by pancreatitis.
• Intravenous (IV) Fluids: Patients receive fluids through a vein in their arm to stay hydrated.
• Nutrition: Patients begin eating again when they can do so without vomiting or experiencing pain. In some cases, a feeding tube may be used.

Gallstones Removal

• Endoscopic Retrograde Cholangiopancreatography (ERCP): If a gallstone obstructs the bile or pancreatic duct, it may be removed using ERCP, a specialised procedure that involves a combination of endoscopy and X-ray imaging.
• Cholecystectomy: This procedure is carried out to remove gallbladder. It’s often recommended after the initial inflammation has settled to prevent the recurrence of gallstone pancreatitis. This surgery can be performed laparoscopically (minimally invasive) or as open surgery.

Gallstone Pancreatitis Complications

• Necrotizing Pancreatitis: A severe condition where pancreatic tissue dies due to inflammation.
• Pseudocyst Formation: Fluid-filled sacs can develop in the pancreas. These pseudocysts can become infected or rupture, leading to internal bleeding.
• Abscess Formation: A confined accumulation of pus may develop inside the pancreas.
• Sepsis: An extreme response to an infection that can lead to organ failure and death.
• Pancreatic Fistula: An abnormal connection or passageway between the pancreas and nearby organs or skin.
• Respiratory Failure: Inflammation can reduce lung function, leading to difficulty in breathing or even respiratory failure.
• Acute Kidney Failure: The kidneys may stop functioning due to decreased blood flow or toxins released during inflammation.
• Disseminated Intravascular Coagulation (DIC): A condition affecting the blood’s ability to clot and can lead to excessive bleeding.
• Bile Duct Injury: The bile duct can become damaged, leading to bile leakage or obstruction.
• Cholangitis: Infection of the bile ducts, which can be life-threatening if not treated promptly.
• Intestinal Obstruction or Paralytic Ileus: The intestines can become paralysed or obstructed due to inflammation.

Proactive Management of Gallstones

Untreated gallstones can lead to severe complications, but they can be proactively addressed with a simple laparoscopic surgery to remove the gallbladder. This daycare procedure allows patients to recover swiftly, often being discharged the next day. Deferring such a surgery, hoping to save on immediate costs, can be counterproductive. The financial and physical toll of treating complications like gallstone-induced pancreatic inflammation can far exceed the straightforward surgical removal of the gallstones. Moreover, the distress and anguish experienced by patients suffering from acute pancreatitis due to untreated gallstones are substantial. Hence, it’s prudent to consider early intervention to avoid these potential outcomes.

Gallstone Pancreatitis Prevention

Preventing gallstone pancreatitis primarily involves addressing the risk factors associated with gallstone formation and taking preventive measures if gallstones are detected.

Diet and Lifestyle

• Maintaining a Healthy Weight: One of the key preventive measures is maintaining a healthy weight. Sudden weight loss can increase the risk of gallstone formation. Individuals on a weight loss journey are advised to shed those extra pounds gradually and responsibly.
• Following a Balanced Diet: Dietary choices play a significant role in gallstone prevention. Opting for a well-balanced diet rich in fruits, vegetables, whole grains, and lean proteins is advisable. It’s important to avoid foods high in fats and cholesterol, as they can contribute to gallstone formation.
• Limiting Alcohol: Excessive alcohol consumption is a known risk factor for pancreatitis. To reduce the risk, it is advised to consume alcohol in moderation or consider abstaining altogether.
• Regular Exercise: Regular physical activity isn’t just about staying fit; it’s also essential for preventing obesity, a risk factor for gallstones. Regular exercise should become part of one’s routine to maintain overall health.

Medications

Healthcare providers might prescribe oral medications like ursodiol (ursodeoxycholic acid) to dissolve cholesterol gallstones in certain situations. It’s important to note that these medications are not suitable for everyone and may require an extended period to show results.

Monitoring Triglyceride Levels

Elevated triglyceride levels can heighten the risk of pancreatitis. If an individual has high triglyceride levels, they should work closely with their healthcare provider to manage and reduce them.

Regular Medical Check-ups

Regular health screenings are invaluable in early gallstone detection. Frequent medical evaluations become even more crucial if individuals have additional risk factors for gallstones or pancreatitis, such as a family history of gallstones.