Gallstone pancreatitis is inflammation of the pancreas that results from blockage of the pancreas duct by a gallstone. This occurs at the level of the sphincter of Oddi, a round muscle located at the opening of the bile duct into the small intestine. If a stone from the gallbladder should travel down the common bile duct and get stuck at the sphincter, it blocks outflow of all material from the liver and pancreas. This results in inflammation of the pancreas that can be quite severe. Gallstone pancreatitis can be a life-threatening disease and evaluation by a physician urgently is needed if someone with gallstones suddenly develops severe abdominal pain.
Risk factors for gallstone pancreatitis are similar to those described for gallstone disease. Female gender, older age, obesity, high cholesterol levels, treatment with estrogen containing medications, rapid weight loss, diabetes and pregnancy are all risk factors.</p
Symptoms may be similar to those discussed in Gallstones and Gallstone Disease. Additionally, the pain may be felt in the left upper abdomen or in the back. It is usually sudden in onset, quite severe, frequently sharp or squeezing in character, and often associated with nausea and vomiting.
Blood tests can identify inflammation of the pancreas (amylase and lipase) and evidence of obstructed outflow of bile from the liver (ALT, AST, alkaline phosphatase and bilirubin). Inflammation of the pancreas is best demonstrated by an abdominal CAT scan, which can also determine the severity of the pancreatic inflammation. CT scans are not as sensitive at identifying small gallstones and an abdominal ultrasound may be ordered if this is considered the cause of the pancreatitis
Pancreatitis is best treated initially by avoiding any intake of liquids and solids until the inflammation subsides. Intravenous delivery of fluids is usually all that’s required if the inflammation is modest and symptoms resolve in a few days. Severe inflammation, persistent pain or fevers suggest severe pancreatitis and ongoing inflammation. Intravenous delivery of nutrients would be started if oral intake cannot be restarted within approximately 5-7 days. Severe nausea and vomiting are treated initially by relieving the stomach of fluid by use of a nasogastric tube and with antinausea medications.Pain therapies may be administered by intravenous until oral treatments and food intake can resume. Sometimes it is important to remove a gallstone causing pancreatitis urgently, and other times it may be appropriate to wait 24-48 hours with regular assessments to assure the individual remains stable. Stones that cause gallstone pancreatitis may pass out of the duct without intervention or may require endoscopic or surgical removal. In cases of infected pancreatic tissue, or a condition called pancreatic necrosis (dead tissue) occurs, antibiotics may be used to control or prevent infection.
Young Choi, MD and William B. Silverman, MD FACG, University of Iowa Hospitals and Clinics, Iowa City, IA