Definition and Overview

The pancreas is one of the most important internal organs. Located deep in the abdomen, it is a vital part of the digestive system. It releases insulin, which controls blood sugar (glucose) levels. Insulin is a hormone that allows the body to use glucose for energy. Without insulin, a person can develop diabetes.

The pancreas can become inflamed for a number of reasons. These include heavy alcohol drinking and certain diseases. If it develops due to gallstones, the condition is called gallstone pancreatitis.

A gallstone can form when there is too much cholesterol or bilirubin in bile. Bilirubin is a chemical that the body produces when it breaks down red blood cells. Bile, on the other hand, is produced by the liver to help digest fats.

Gallstones can block the pancreatic ducts. When this happens, all materials from the pancreas and the liver become trapped. As the substances accumulate in the area, the pancreas starts to swell.

Causes of Condition

Studies show that up to 80% of gallstones are made of cholesterol. The rest are made of calcium salts and bilirubin. Doctors are not sure as to what causes them to form. However, there are possible explanations. These include the following:

  • High levels of cholesterol in bile - Gallstones can form if the amount of cholesterol excreted by the liver is more than what bile can dissolve. If excess cholesterol builds up, crystals may start to form. These can eventually turn into gallstones.

  • High levels of bilirubin in bile - Certain medical conditions can cause the liver to produce too much bilirubin. These include scarring in the liver and biliary tract infections. Excessive amounts of bilirubin in bile increase the risk of gallstone formation.

  • Gallbladder disease - The main function of the gallbladder is to store and release bile. However, certain conditions, such as cholecystitis, can cause it to lose its normal function. If it does not empty completely, it can cause the bile to become very concentrated. This also increases the risk of gallstone.

Other factors that can increase one’s risk of the condition are the following:

  • Lifestyle factors - These include a diet that is high in cholesterol and fat. Being overweight or obese is also a risk factor.

  • Diabetes mellitus - For reasons that aren’t fully understood, many people with diabetes also have gallstones.

  • A family history of gallstones - People with close family members with the condition are more likely to develop it as well.

Key Symptoms

The most common sign of the disease is a sudden onset of severe pain. It often starts on the left side of the upper abdomen. The pain often radiates to the back and shoulders. Other symptoms include nausea and vomiting. Fever, chills, and loss of appetite are also common.

Unless treated promptly, the condition can lead to serious complications. These include the following:

  • Pancreatic infections - The disease increases the risk of infection due to the build-up of substances in the biliary system. This is a serious complication that must be treated promptly. Its treatment involves removing the infected tissue through surgery.

  • Kidney failure - The disease can cause the kidneys to fail. Treatment for this condition is regular dialysis in which a machine is used to filter the blood.

  • Pancreatic cancer - The disease is one of the risk factors for cancer of the pancreas.

Who to See and Types of Treatments Available

Gallstone pancreatitis is treated by gastroenterologists. These are doctors who specialise in the treatment of disorders that affect the digestive system.

They diagnose the condition using the following tests:

  • Blood tests - Blood tests are used to evaluate the function of internal organs. These include the gallbladder, liver, and pancreas. They measure the levels of different enzymes in the blood. Test results that fall outside the normal range indicate abnormalities.

  • Stool analysis - This test can detect fats in the stool. This is a sign of malnutrition. It can occur when the pancreas stops producing enzymes that the body needs to digest fat.

  • CT scan - This is an imaging test used to rule out other possible causes of symptoms. It can confirm if the pancreas has enlarged. It can also show if fluid has accumulated in the peritoneal cavity.

  • Ultrasound - This test can detect the presence of gallstones. It can also confirm inflammation in the biliary duct.

  • MRI - This test creates images of the pancreas. It allows doctors to determine any changes in its shape and structure. It can also be used to detect gas and calcifications.

Treatment of the condition may involve:

  • Fasting - Patients with the condition are often hospitalised. They are not allowed to eat solid food until their pancreas is no longer swollen. They receive nutrients through intravenous or tube feeding methods.

  • Antibiotics - Antibiotics are used to treat or prevent infection from occurring.

  • Pain medications - Many patients suffer from intense pain because of their condition. Thus, their treatment always includes the use of painkillers.

  • Surgery - Some cases require the surgical removal of the gallstone and/or gallbladder to treat the condition.

The overall outlook for patients depends on the severity of the condition. If the pancreas is only mildly swollen and is treated promptly, the prognosis is excellent. However, patients with a severely damaged pancreas are at risk of developing serious complications. Some of them can be life-threatening.

References:

  • Feldman M, et al. Gallstone disease. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016.

  • American College of Gastroenterology. Young Choi, MD and William B. Silverman, MD FACG, University of Iowa Hospitals and Clinics, Iowa City, IA

  • Portincasa P, et al. (2016). Preventing a mass disease: The case of gallstone disease: Role and competence for family physicians. DOI: 10.4082%2Fkjfm.2016.37.4.205

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