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Gallstones are a common cause of acute pancreatitis.
Acute pancreatitis is a sudden inflammation of your pancreas, a comma-shaped organ located between your stomach and spine. In addition to producing hormones that control your blood glucose, your pancreas releases digestive enzymes through a duct attached to the upper part of your small intestine. According to a September 2012 review in вЂњSurgery,вЂќ a gallstone blocking the pancreatic duct is the most common cause of acute pancreatitis, accounting for up to 75 percent of cases.
The pancreatic duct enters your small intestine through a small portal called the ampulla of Vater. This is the same entryway used by the common bile duct, which transports bile from your liver and gallbladder to your intestine. This anatomical arrangement facilitates the addition of bile and digestive enzymes to the food in your intestine, which are needed for optimal nutrient absorption. Gallstones traveling through the common bile duct may lodge at the ampulla of Vater, creating a situation that could trigger acute pancreatitis.
Gallstones and Pancreatitis
Although it's not exactly clear how gallstones start pancreatic inflammation, a July 2009 review in вЂњThe Saudi Journal of GastroenterologyвЂќ offered a generally accepted explanation. As the lodged gallstone interrupts the flow of bile, bacteria from your intestine move into the ducts leading to your pancreas, gallbladder and liver. This triggers inflammation and swelling in the pancreatic duct. The resulting back pressure in the pancreatic duct damages the cells that produce digestive enzymes, leading to premature enzyme activation, injury of pancreatic tissue and widespread inflammation of the pancreas. Once a gallstone passes or is removed, the pancreatic inflammation usually ends.
Because acute pancreatitis can be triggered by several other causes -- alcohol, medications or infections, for example -- it is important to determine whether a gallstone caused the inflammation. This can be difficult because up to 85 percent of patients with gallstone pancreatitis pass their stones on their own, and some stones pass before tests can be done. Blood tests, ultrasound, CT scans, MRI and direct viewing of the ampulla of Vater through a scope are among the tests a doctor may use to diagnose gallstone pancreatitis.
Acute pancreatitis is a serious problem, regardless of its cause. While most people recover and their pancreas returns to normal, 2 to 7 percent of patients do not survive. So, aggressive medical management -- intravenous fluids, pain medications, nutritional support and antibiotics -- will be started while the tests are being done.
If you have a gallstone lodged in your ampulla of Vater, your doctor may remove it by passing a scope down your throat and into your upper intestine. Or, your surgeon may choose to remove the stone through a laparoscope inserted through your abdomen. Your gallbladder could be removed at the same time if your pancreatic inflammation is relatively mild. If your pancreas is severely inflamed, your doctors might wait until your pancreatitis improves before removing your gallbladder. In any event, gallbladder removal is necessary to prevent another stone from causing another episode of pancreatitis.
Timing of Gallbladder Removal
Many experts feel patients with gallstone pancreatitis should have their gallbladders removed before they are discharged from the hospital. Gallstone pancreatitis is likely to recur after the first episode, and the risk of death or major complications increases with each recurrence. Some surgeons opt to bring patients back for gallbladder removal several weeks after their first hospitalization, when pancreatic inflammation has subsided. Your physician will choose the approach that works best for you.