You've had gall bladder attacks before, but this one is different. The pain is severe, radiates to your back or shoulder, has lasted more than two hours and might be accompanied by fever. Exhausted, you arrive at the hospital expecting to have gall bladder surgery. Instead, doctors inform you that the pain is caused by gallstone pancreatitis. A mild attack generally resolves when the gallstone passes out of the common duct or is endoscopically or surgically removed. Surgery to remove the gall bladder might be delayed during acute pancreatitis.
Cause
Gallstones are formed mainly from cholesterol in the gallbladder. They cause abdominal pain, nausea, and vomiting by blocking the bile ducts, which drain from the gallbladder. According to the American College of Gastroenterology, gallstones also can block the flow of digestive enzymes from the pancreas, which shares a common duct with the gallbladder, and become lodged in the sphincter leading to the intestines. The results of trapped digestive juices is the inflammation of pancreatic tissue. This condition is called gallstone pancreatitis.
Diagnosis
Although CT scans, ultrasounds and blood levels of pancreatic enzymes can alert physicians to inflammation, there is no one test to help doctors diagnose or predict the severity of acute biliary pancreatitis (ABP), or gallstone pancreatitis. Doctors rely on clinical skills to recognize severe pancreatitis, which affects the type and timing of treatments. In a 2006 study published in "Advances in Surgery," researchers at the University of Texas concluded that the management of ABP involves close observation and a high degree of collaboration between the surgeon, radiologist, gastroenterologist and intensive care specialist.
Risk Factors
According to an article on gallstone pancreatitis by Kathy Dix, published in "Endonurse," 20 million adults in the United States have gallstones, but only 4 percent of these are troubled by symptoms, and 5 percent of those people develop pancreatitis. Dix writes that most victims fit the profile of five F's: fair skinned, overweight (fat), female, fertile (using birth control) and at least 40 years old. Rapid weight loss, diabetes and pregnancy are also conditions associated with gallstone pancreatitis.
Complications
Severe ABP can be fatal, with most late deaths caused by infection, according to the American College of Gastroenterology. Other complications are organ failure, pneumonia, kidney damage, liver failure or heart disease. Pancreatitis might require admission to intensive care to monitor blood pressure, oxygen, urine output, fever and confusion. Recovery from an attack of severe ABP might take months. Fluid might need to be drained. And surgery might be needed to remove dead tissues.
Treatment
Because pancreatitis recovery is slow, even when it is uneventful, nutrition is usually the biggest challenge. Clear liquids (gelatin, broth) and intravenous fluids rest the pancreas; eating might cause pain or vomiting. Pancreatic enzymes are prescribed to aid digestion, and medication is needed for pain relief. The patient who can't eat might be fed through a gastric tube that bypasses the pancreas, or nutrients might be administered into the bloodstream.
