What Is Gallstone Pancreatitis?

This article discusses the condition called gallstone pancreatitis which is not a rare condition and one which often results in hospitalisation and surgery. This condition affects the pancreas which is a large and important part of the digestive system. 

Gallstone pancreatitis is a serious condition that develops when a gallstone blocks a duct in the pancreas and causes inflammation in this digestive organ. Pancreatitis can be either acute or chronic and has many different causes; gallstones are a common cause of acute pancreatitis.

Read on and learn all about this condition including its causes, signs and symptoms, and how it is diagnosed and treated. Reading about the risk factors is particularly important as there are steps you can take to prevent this potentially life-threatening condition such as dietary and lifestyle changes that reduce the risk of developing gallstones.

Overview

This article discusses the condition of gallstone pancreatitis which develops as a result of having gallstones which have moved to a position where they are blocking ducts to the pancreas and causing pressure and inflammation. A hospital stay will most likely be needed as gallstone pancreatitis can be very serious and often surgical intervention is required to cure this condition. 

The pancreas is a large gland located behind the stomach that forms part of the digestive system. Digestive juices and hormones, including the hormone insulin, are created in the pancreas. The digestive juices formed in the pancreas leave the pancreas via a tube called the pancreatic duct and travel to the duodenum - part of the small intestine. Gallstone pancreatitis occurs when the pancreatic duct becomes blocked by a migrating gallstone. The fluid becomes blocked and backs up, potentially travelling back up the pancreatic duct or the bile duct. Gallstone pancreatitis is also known as biliary pancreatitis.

Causes of gallstone pancreatitis

The cause of gallstone pancreatitis is having gallstones that then move and block the duct from the pancreas. 40% of cases of acute pancreatitis are caused by gallstones, and any person who has developed gallstones has a 7% risk of developing acute pancreatitis.¹

The gallstones, or gallstones, exit the gallbladder and become lodged in the pancreatic duct, causing irritation to the pancreas.² The obstruction of the duct by gallstones causes pressure to build up as it activates digestive enzymes, leading to a buildup of fluid.³

Signs and symptoms of gallstone pancreatitis

The main symptom of acute pancreatitis is severe stomach pain that develops very suddenly in the centre of the stomach. This stomach pain can get increasingly severe and travel into the upper back. Other signs and symptoms of acute pancreatitis can include the following:

• A high temperature of 38℃ or more
• Indigestion
• Feeling nauseous or vomiting 
• Tenderness and swelling of the stomach
• Yellowing of the whites of the eyes and the skin known as jaundice
• Rapid breathing 
• Fast heartbeat (tachycardia)

Management and treatment for gallstone pancreatitis

Treatment of gallstone pancreatitis will usually be carried out in a hospital and often will require surgery or endoscopy. Guidelines for the management of gallstone pancreatitis are published by the British Society of Gastroenterology, and these suggest that all patients with mild gallstone pancreatitis should be offered an operation called a cholecystectomy if they are fit for the surgery. This operation involves removing the gallbladder and is called a ‘definitive treatment’ as further gallstones will not be formed.⁴ If the patient is not considered fit enough for the surgery, they can be offered an endoscopic sphincterotomy, which is where the biliary sphincter and a segment of the common bile duct are cannulated and then cut.

Alongside surgical options that treat the underlying cause of this illness, the following may be used to manage patients:

• Administration of fluids to treat or prevent dehydration
• Pain relief
• Oxygen, possible ventilation 
• Antibiotics 
• Nutritional support 

Diagnosis

There are three criteria used to diagnose gallstone pancreatitis, which will be looked at using a combination of examination, blood tests, and scans. Of the three criteria below, two must be found to confirm the diagnosis of gallstone pancreatitis.¹

• Upper abdominal or back pain consistent with pancreas-type pain
• Increased pancreatic enzyme levels
• Pancreatic inflammation found from imaging (usually CT scans)

Blood tests are used to assess the enzyme levels and the body scans also assess the level of inflammation and can be a CT scan, MRI scan or an ultrasound scan.

Complications

During acute pancreatitis local and systemic complications can occur; local complications would affect the pancreas itself and systemic complications could lead to problems in other body systems.

Local complications could include:¹

• Acute peripancreatic fluid collections
• Acute necrotic collection, indicating necrosis or tissue damage in the pancreas
• Mesenteric vein thrombosis
• Mesenteric vein infection

Systemic complications could include:¹

• Systemic Inflammatory Response Syndrome (SIRS). This is where the body overreacts to a trigger to defend itself. In the case of gallstone pancreatitis, it is overreacting to inflammation but this syndrome can be triggered by infection, trauma and malignancies amongst other things.
• Acute respiratory distress syndrome (ARDS)- a complication of gallstone pancreatitis which is life-threatening as the lungs cannot provide the vital organs with enough oxygen 
• Single or multiple organ failures

Over a longer term, acute pancreatitis and gallstones can increase the risk of pancreatic cancer, but it is rare for gallstone pancreatitis to cause recurrent or chronic pancreatitis. Gallstones can cause inflammation of the gallbladder, which is known as cholecystitis. 

FAQs

How can I prevent gallstone pancreatitis?

As gallstone formation is the cause of gallstone pancreatitis, the best approach to preventing this condition is to try to avoid it developing in the first place. Eating a balanced diet which is low in sugar, high in fruit and vegetables, and high in quality fibre such as wholegrains is the best prevention. 

How common is gallstone pancreatitis?

The total amount of cases of acute pancreatitis is 56 cases per 100,000 people every year; of these, half are caused by gallstones.⁵

Who is at risk of gallstone pancreatitis?

Anyone who has already developed gallstones has a 7% risk of developing gallstone pancreatitis.¹ As we age, the risk of developing gallstone pancreatitis increases. Other factors that may increase the risk of biliary obstruction include obesity, rapid weight loss and even pregnancy.

How long does gallstone pancreatitis last?

Acute gallstone pancreatitis usually improves within one week with patients becoming well enough to leave the hospital after 5-10 days. The length of recovery from gallstone pancreatitis will depend on the severity of the illness and if any complications have occurred. Severe gallstone pancreatitis may take longer to recover from and require further medical treatment. 

When should I see a doctor?

Any signs and symptoms of having developed gallstones should prompt a visit to the doctor. Symptoms to look out for may include abdominal pain after eating, nausea and vomiting and appetite loss. If experiencing any severe abdominal pain, back pain or jaundice, then urgent medical attention may be required. 

Summary

Gallstone pancreatitis is a serious condition, usually requiring hospital care. Often, surgery is required to control the condition and prevent its recurrence. It can vary in severity from relatively mild to very severe, and the complications can be life-threatening. The main risk factor for developing this condition is having developed gallstones, which then travel from the gallbladder and become lodged in the pancreatic duct. Understanding why gallstones develop in the first place, as well as maintaining a balanced diet and healthy lifestyle, are the key factors to prevent this painful condition.