Have you ever heard that gallstones can cause the pancreas to become severely swollen or inflamed? This is what doctors call `(Gallstone Pancreatitis)` or `(Biliary Pancreatitis)`. This can actually be a serious condition. But don't worry, because there are good treatments for this. Today, we will talk about everything in a simple way that you can understand.
So what is this pancreas?
Simply put, the pancreas is an important organ located inside our abdomen, behind the stomach. It's like a little factory in our body. It produces the most important digestive enzymes that help us digest the food we eat. When we eat, and the food reaches the small intestine, the pancreas receives a signal to release these enzymes. These enzymes travel from the pancreas along a small tube (the pancreatic duct) and join a slightly larger tube (the common bile duct). It is along this large tube that the enzymes, along with the bile from the liver and gallbladder, go to the upper part of the small intestine. That's where the digestion process actually takes place.
Okay, so what are these gallstones?
Gallstones form in our gallbladder. The gallbladder is a small sac that collects and stores bile, which is made by the liver. This bile contains various substances. Sometimes, if there is too much cholesterol or bilirubin in this bile, it can become like sludge at the bottom of the gallbladder. If the gallbladder is not emptied properly, this sludge-like material can accumulate and over time form stones. These are what we call gallstones.
Is pancreatitis caused by gallstones dangerous?
Yes, this is a serious condition . If you develop pancreatitis, it is important to seek medical attention as soon as possible. Symptoms may be mild or severe. However, the longer you don't get treatment, the worse the condition will get. Especially if a stone is stuck in the bile ducts, the more likely it is to develop complications. In severe cases, it can be life-threatening.
How common is this disease?
Gallstones are a common problem for many people. But not everyone has them. For example, in the United States, it is estimated that 10% to 15% of people have gallstones. But only 0.1% of those people develop pancreatitis due to gallstones. Acute pancreatitis affects about 0.4% of the population in the United States. Gallstones are the cause of about 35% of these cases. The second most common cause is alcohol use.
What are the causes of gallstones?
It's difficult to pinpoint a single cause of gallstones, but several factors may contribute to them:
- If your blood cholesterol levels are high, it could be due to the food you eat or a metabolic disorder. In that case, cholesterol can also accumulate in your bile.
- If you have liver disease, bilirubin levels in your blood and bile may increase.
- If there is a functional disorder in which the gallbladder does not empty properly.
- Excess estrogen can also delay gallbladder emptying. This is why this risk is higher during pregnancy.
How do gallstones cause pancreatitis?
Imagine that your pancreas, gallbladder, and bile duct are connected to each other by a tube called the common bile duct. Normally, bile from your gallbladder flows through this common bile duct into your small intestine. But if you have gallstones, they can also travel through this duct.
Although stones pass easily when they are young, they gradually get larger as new bile passes over them. So, a stone that used to pass easily can become stuck later, especially if the duct is narrow. A gallstone can either get stuck inside the pancreatic duct or get stuck outside the duct, causing pancreatitis.
There are two theories about how this blockage causes pancreatitis:
1. The first theory is that when a stone becomes lodged outside the common bile duct, bile can flow backward into the pancreas. Bile is highly corrosive, which irritates the pancreas.
2. The second theory is that pancreatic enzymes are responsible for the inflammation. These enzymes are designed to digest proteins, carbohydrates, and fats in the small intestine. Therefore, they are also highly corrosive. Although our small intestine is protected from these by a thick mucus lining, the pancreas does not have such protection.
Normally, pancreatic enzymes are activated after they reach the small intestine. However, if excessive pressure is created due to a blockage in the pancreatic duct, the enzymes can be activated by that pressure.
However, we know that there is a cause-and-effect relationship between gallstones and acute pancreatitis. When you go to the hospital for treatment, the pancreatitis will heal once the stones in the bile ducts are removed.
What are the symptoms of pancreatitis caused by gallstones?
The symptoms that are commonly seen are:
- Severe stomach pain. You may feel this in the upper left side of your abdomen, where your pancreas is. It may feel like a knife stabbing you or squeezing you from the inside. This pain may also radiate to your chest, shoulder, or back.
- Nausea and vomiting.
As the condition becomes more severe, symptoms such as these may also occur:
- Abdominal bloating.
- Dehydration.
- Heart rate increases.
- Rapid breathing or difficulty breathing.
- Low blood pressure.
- Low body temperature.
- Fever and chills.
- Jaundice (yellowing of the eyes and skin).
What are the complications of pancreatitis caused by gallstones?
If your pancreas continues to be severely inflamed, its tissues will gradually become damaged and the blood supply will begin to decrease. This can lead to the pancreas losing its function. The continued inflammation can cause fluid to accumulate in the tissues between the organs (peritonitis). This fluid can spread up into the chest cavity, pressing on the lungs and heart. As this fluid accumulates, the body's blood volume decreases, causing severe dehydration. This can cause the kidneys to retain fluid, eventually leading to a dangerous condition called hypovolemic shock.
When a stone becomes blocked in the bile duct, it can cause problems for other organs connected to that duct system. Bile can back up into the liver and gallbladder, causing cholecystitis and liver disease. When the pressure in the ducts increases, digestive fluids like bile can leak into the bloodstream. A blockage can allow bacteria from the small intestine to back up into the ducts, causing an infection. If this infection spreads to the bloodstream, it can cause a systemic infection that affects the entire body and can even lead to a fatal condition called septic shock.
How is this disease diagnosed?
When you come to the hospital with typical symptoms, the doctor will first do a blood test to check your pancreatic enzyme levels. They will also check your liver enzyme levels to see how much damage has been done to your liver. Then, they will do imaging tests to look at your pancreas and determine the severity of the inflammation.
An abdominal ultrasound can detect gallstones in the bile ducts. If necessary, a CT scan can look at the pancreas in more detail. Sometimes, by the time you come in for treatment, the original stone that started the inflammation may have passed on its own. But if there are other stones around, doctors can figure out that it is the cause.
How is pancreatitis caused by gallstones treated?
If your condition is severe, you will be admitted to the intensive care unit. In most cases (about 80%) if your condition is not that severe, supportive care is the first treatment. This is the only treatment for pancreatitis.
Supportive care
Treatment begins as follows:
- IV fluids: Because many people are dehydrated, blood volume needs to be restored. The medical team will put a saline catheter into a vein in your arm or hand and continue to give you fluids. These fluids also contain electrolytes.
- Pain relief: Many people have severe pain, so strong painkillers must be given either as an injection or through saline.
- Bowel rest: You will need to stop eating until your pancreas calms down. This is because when you eat, your digestive system becomes active, signaling your pancreas to release more enzymes and your liver and gallbladder to release more bile. This can further increase the pressure on your bile ducts, making the condition worse.
- Nutritional support: Depending on the severity of your condition and the length of your hospital stay, your medical team may add a small amount of glucose to the saline solution to give you energy. They may also give you nutrition through a nasogastric tube or saline solution.
In addition, these treatments can also be done:
- Nausea medicine.
- Giving oxygen.
- Antibiotics if an infection is confirmed.
- Inserting a nasogastric (NG) tube through the nose into the stomach to remove fluid from the stomach.
- Inserting a urinary catheter to remove urine and measure the amount of urine that comes out.
You will need to be on this supportive care until your pancreas starts to calm down. In less severe cases, this will usually resolve in a few days. Supportive care can also help a stone pass on its own before it becomes more serious.
Gallstone removal methods `(Gallstone interventions)`
Sooner or later, any gallstones that are stuck in your ducts will need to be removed. This may be done as an emergency surgery, or after supportive care. It depends on your condition. Even if the original stone that caused the blockage is gone, all other stones will need to be removed.
You may need to do one or both of these methods:
- ERCP (Endoscopic retrograde cholangiopancreatography): This is called ERCP for short. This is a procedure that is actually an internal examination, and it also allows doctors to correct any problems they encounter at the time. The bile ducts are examined using X-rays and an endoscope (a long tube with a camera attached). This endoscope is inserted through the throat into the stomach, and then another tube is passed through it into the bile ducts. The doctor can see these ducts using fluoroscopic X-ray technology. Instruments can be passed through the tube to remove gallstones and stents can be placed to relieve blockages.
- Gallbladder removal: If you have gallstones that have caused you to be hospitalized, you are more likely to have problems with them again. Therefore, the only treatment for gallstones that are causing problems is to remove the gallbladder. It is a very safe and effective procedure. This is usually done through a laparoscopic cholecystectomy. This means that a few small incisions are made and a camera called a laparoscope is inserted through one of the incisions to remove the gallbladder. Some people, depending on their condition, may also need to have traditional open surgery.
Can pancreatitis caused by gallstones be prevented?
If you have had symptoms of gallstones before, that's a warning sign . You should definitely get them checked out and removed if you have them. Biliary colic is a red light. It's a pain that occurs on the right side of your abdomen, just below your right rib cage, where your gallbladder is located. It may be worse after eating and may be accompanied by nausea. If this biliary colic comes and goes, it means that there is a blockage, but not a complete blockage, in the gallbladder or bile ducts. This pain can come and go as the gallbladder contracts and expands. It can easily turn into something more serious.
Important: Symptoms such as stomach pain and nausea, especially after eating, may be a sign of `(biliary colic)`. Never ignore the pain. Seek medical advice to determine the cause. The sooner you get treatment for pancreatitis, the better your recovery outcome.
How long will this situation last?
This usually doesn't go away on its own. But if you have a relatively mild, uncomplicated condition, a few days of supportive care in the hospital is fine. However, you may still need to have a splint removed.
How long does it take to recover after treatment?
Many people have to have a cholecystectomy to remove their gallbladder. The recovery time depends on what type of surgery you have. It takes about two weeks to recover from laparoscopic surgery. If you have open surgery, it takes about six to eight weeks.
What is the recovery status of people who are hospitalized with pancreatitis due to gallstones?
Unless you have a serious or complicated condition, you can expect to make a full recovery. Gallbladder removal is considered a minor surgery, with few complications. Even without your gallbladder, your digestive system can function normally.
About 20% of cases are severe or complicated. In such cases, it is difficult to reverse the damage that has already been done. Even with intensive care, about 25% of such cases can be fatal. Those who survive must stay in the hospital for weeks to recover.
If you don't know you have gallstones (and many people don't), you may be surprised and worried when you suddenly develop pancreatitis due to gallstones. The pain can be severe and may seem to come on for no reason. If you think you might have gallstones, it's wise to get tested early.
The most important things to keep in mind (Take-Home Message)
Okay, so here are some things you need to remember from what we've talked about:
- Gallstone pancreatitis is a serious condition. So if you experience symptoms, see a doctor immediately.
- The main symptoms may be severe pain in the upper abdomen, especially on the left side, nausea, and vomiting .
- The longer treatment is delayed, the more complications may occur.
- If you know you have gallstones, or have previously had symptoms like `(biliary colic),` be aware of it.
- Often, removing the gallbladder is the permanent solution, and it is a safe surgery.
- If you experience pain in the upper right side of your abdomen after eating, it could be a sign of gallstones. Talk to a doctor about it.
If you don't panic, get proper medical advice, and get the right treatment, you can fully recover from this condition. If you have any further questions, don't hesitate to talk to your doctor.
` Gallstones, Pancreatitis, Gallstone Pancreatitis, Stomach ache, Gallbladder removal, ERCP, Pancreatitis, Bile
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