The pancreas is a gland of the digestive system, located behind the stomach and intestines. It has 2 main purposes: it produces important hormones like insulin, necessary for growth and metabolism. It also plays a role in digesting, by creating and secreting pancreatic juices or enzymes, which help break down food. The pancreas transports these juices to the stomach, through a duct. The biliary system also drains bile into the stomach, through a duct. So both ducts meet to drain together into the stomach, through an opening called the Ampulla of Vater.
Gallstones are concentrates of calcium or cholesterol, when accumulation of bile takes place. These stones tend to remain in the gallbladder, but if they move around, a gallstone could enter the common duct of the pancreas and biliary system and block the pathway. Hence the flow of bile and pancreatic juices is blocked. This is the cause of pancreatitis due to gallstones. Gallstone Pancreatitis is the condition where the pancreas is swollen or inflamed, due to accumulations of gallstones.
There are two types of gallstone pancreatitis based on occurrence of the condition. Acute gallstone pancreatitis is a singular or rare occurrence of gallstone pancreatitis. It goes away after a few days with or without treatment. Some cases of acute pancreatitis can be serious with life-threatening consequences. Chronic gallstone pancreatitis is a persistent or recurring gallstones blockage. The pain is less as compared to acute. But the blocked pathway is more damaged, with scarring.
It is commonly observed that those with a history of gallstones are more susceptible to this form of gallstone attack. But symptoms are mostly observed among patients defined by the 5 F's criteria: female, fat, fertile, fair and above 40. In fact, the female gender on a whole, is highly vulnerable to gallstone blockage in this area. Approximately three-fourth of all gallstone pancreatitis patients are women.
Gallstone pancreatitis has a varying rate of occurrence based on ethnicity as well. In developed countries like European nations, the occurrence of this condition is very high. An estimated 80,000 cases occur in the United States, annually. The following are some common signs of gallstones in the pancreas, divided into various categories.
Mild and Early Symptoms
- Vomiting and diarrhea
- Swollen abdominal area
- Fever and chills
- Nausea and loss of appetite
- Continuous feeling of fatigue or tiredness
- Feeling faint or dizzy
- Going into shock
- Low blood pressure
The predominant symptom is pain. Pain can start in the abdominal area, just below the ribs. It can travel and radiate to the back, making the patient wish to curl or contract into himself, like a ball. The severity of pain also differs. Some feel a horrible shooting pain come up suddenly. Some feel the pain after eating a meal, building up in the body, until it becomes unbearable. And some patients feel nothing at all, this is commonly observed in those with kidney problems or diabetes.
Diagnosing gallstone pancreatitis can be confusing, as its symptoms are similar to those of digestive system disorders. A thorough physical examination and evaluation of medical history is carried out first. Initial diagnostic tests include blood work and tests. High levels of enzymes like amylase and lipase, are a possible sign of gallstone accumulation. Function tests of the liver and renal system are carried out to see if those organs are working properly. Physical proof of the presence of gallstones is obtained by imaging tests like an abdominal ultrasound, endoscopic ultrasound and CT (computerized tomography) scan.
Treatment options depend on the severity and duration of the pain caused by the gallstones. Hospitalization for a few days is required for monitoring and some specific treatment methods. The patient should not eat food through the mouth, instead he/she is fed intravenously, to lessen the strain on the pancreas. Painkillers may be prescribed to ease the pain. In severe cases, intensive support is required.
Surgery is used to remove the gallstones blocking the passage or to remove any infected or damaged pancreatitis tissue, which cannot heal a procedure termed as a necrosectomy. Those with a history of gallstones, should be careful in correctly identifying symptoms in time, so as to avoid painful complications.