Gall Stone pancreatitis

On average 5 percent of gall Stone patients develop pancreatitis. Gallstone pancreatitis is caused when a migrating  gallstone obstructs the ampulla of Vater.  Acute pancreatitis is a clinical syndrome consisting of epigastric abdominal pain, often radiating to the back; nausea;  vomiting (not always present); and a serum amylase or lipase level greater than three to five times normal," 

Serum amylase and lipase levels are not the only indicators of acute pancreatitis; C-reactive protein, leukocyte elastase, trypsinogen-activating peptides and lactate dehydrogenase are also gauges but are rarely tested by clinicians. 



Risk factors for gallbladder disease besides the "five Fs" (fair, fat, female, fertile and 40-plus years of age) include a  larger-diameter cystic duct, a larger-diameter common bile duct, high basal sphincter of Oddi pressure, more pancreatic  duct reflux and a common pancreatobiliary channel.

How prevalent is it?

Gallstone pancreatitis is typically seen in patients described by the five Fs. 

How is it caused?

The cause of gallstone pancreatitis is debatable. Reflux of bile into the pancreas by a common channel may contribute; this is a controversial theory, but supported by the fact that there have been gallstones recovered in the feces of 85 to 95 percent of gallstone pancreatitis cases.

Imaging Options

Computerized tomography (CT) is one choice for imaging the pancreas. CT allows the identification of pancreatic edema, fluid or cysts, and it allows the severity of pancreatitis to be graded. 

How can gallstone pancreatitis be treated?

The use of ERCP in patients with gallstone pancrea  titis is controversial. The literature indicates that in patients without biliary obstruction, ERCP does not benefit them and may even produce complications that make the disease worse. 

It is not necessary to perform preoperative ERCP in all patients undergoing laparoscopic cholecystectomy; the surgeon should, alternatively, perform intraoperative cholangiography, with ERCP incorporated if bile duct stones are found. However, patients with a suspected or known surgical reconstruction of the gut should undergo preoperative ERCP, which may help the surgeon plan her approach.Preoperative ERCP should also be performed in patients with persistent or progressive biliary obstruction (regardless of choledocholithiasis); surgery should then follow the bile duct clearing to prevent any additional migration of stones from the gallbladder. "Because ERCP and sphincterotomy combined are associated with much higher morbidity and mortality than is laparoscopic cholecystectomy -- partly owing to the large number (more than 500,000) of cholecystectomy procedures performed annually in the U.S. alone -- endoscopists performing ERCP prior to laparoscopic cholecystectomy must consider the medicolegal consequences in the event of a severe complication (usually severe pancreatitis) related to the
procedure," 

Typically, if gallstones are confirmed but are not symptomatic, removal of the gallbladder is not recommended. 

Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) does increase morbidity in severe pancreatitis patients and is contraindicated "unless expertise is available for therapeutic options," Bjork says. "The therapeutic ERCP with endoscopic sphincterotomy and drainage of the bile duct with extraction of gallstones is of primary importance in the therapy of cholangitis. Even though pancreatitis may occur with endoscopic sphincterotomy, the procedure does not exacerbate the pancreatitis or have a higher incidence of perforation or hemorrhage in patients with gallstone pancreatitis. If drainage is not possible by therapeutic ERCP or the patient is unable to be sedated, percutaneous transhepatic cholangiography is a possible consideration, especially with dilated intrahepatic ducts."3

"The management of gallstone pancreatitis is variable. 

Laparoscopic cholecystectomy is considered the procedure of choice to prevent recurrent pancreatitis and to evaluate the bile duct," reports Bjork. "An early therapeutic ERCP may prevent recurrence of pancreatitis or prevent the complications of cholangitis and necrotizing pancreatitis. Routine preoperative ERCP is not indicated since gallstone pancreatitis usually responds to conservative therapy and subsequent laparoscopic  cholecystectomy."

"Gallstone pancreatitis usually responds to conservative medical therapy, but it is important to identify those patients 

who require urgent endoscopic therapy in order to shorten the course of the disease and prevent pancreatic complications. 

The majority of patients require laparoscopic cholecystectomy to prevent a recurrence of the pancreatitis," he concludes.

What products are used for patients?

Some "natural" remedies have value as preventive medicine. 

(i) Extra doses of vitamin C may help the body to digest dietary  fat and thus lower the risk of gallstones. Other supplements may have use in preventing gallstone  formation, such as: Lipotropic factor combination (which includes choline, methionine, folic acid and vitamin B12)
(ii) Cholagogues and choleretics (such as milk thistle and dandelion)
(iii) Lecithin (insufficient levels have been linked to gallstones)
(iv) Psyllium ( aka Isabgole which binds to cholesterol in bile and prevents gallstone formation, and prevents constipation, which also 
contributes to gallstones)
(iv) Peppermint oil (which stimulates the flow of bile and is a terpene, which may help dissolve gallstones) 

Patients can reduce their risk of gallstones by sticking to a high-fiber, low-fat, low-sugar diet, by drinking plenty of  water and by maintaining a healthy weight. Exercise, regular bowel movements and a diet that includes fish rich in omega-3 oil also help.