Pancreatitis with gallstones

About 40% of all patients hospitalized in the US with acute pancreatitis have it due to gallstones. Pancreatitis caused directly by gallstones is called gallstone pancreatitis. Gallstone pancreatitis is a serious illness that can be life-threatening. In the last 15 years, I have treated hundreds of patients hospitalized with gallstone pancreatitis. I am writing this article based on my personal experience as well as a review of medical literature.

In this article, I will explain:

  1. How gallstones lead to pancreatitis
  2. What happens inside your pancreas when you have acute gallstone pancreatitis
  3. How to recognize the symptoms of acute pancreatitis from gallstones
  4. When you need to be hospitalized for pancreatitis with gallstones
  5. What to expect when hospitalized for gallstone pancreatitis

How gallstones lead to pancreatitis

Not all gallstones lead to pancreatitis. There are about 20 million people with gallstones in the United States. Luckily, less than 0.1% of people with gallstones end up having gallstone pancreatitis.

A diagram showing how gallstones may cause pancreatitis
How gallstones may cause pancreatitis

Gallstones don’t cause pancreatitis if the stones remain inside the gallbladder where they are formed. The gallbladder and the pancreas both drain into your upper intestine. Gallbladders carry bile, while the pancreas carries digestive enzymes. When gallstones come out of the gallbladder, they may block the flow of pancreatic enzymes. If pancreatic enzymes can’t flow freely, they trigger certain events that may lead to acute gallstone pancreatitis.

What happens inside your pancreas when you have acute pancreatitis from gallstones

When we say something is acute in medicine, we mean that it happens fast and lasts for a relatively short amount of time. Acute pancreatitis is the inflammation of your pancreas that occurs very quickly. In pancreatitis from gallstones, this inflammation is triggered when gallstones block the flow of pancreatic enzymes. The enzymes then start flowing backwards and accumulate inside the pancreas. This increases the pressure inside the pancreas, and may lead to injury of the cells inside the pancreas that make digestive enzymes.

The injured pancreatic cells may end up activating and leaking the digestive enzymes inside the pancreas. These enzymes are supposed to be activated and released into the intestine only when there is food that needs digesting. Digestive enzymes are very corrosive due to being designed to break down protein, fats, and other nutrients. When these corrosive enzymes are activated and released prematurely, they start to digest anything they come in contact with. Your own body tissue gets inflamed and damaged as a result of the actions of the freed enzymes.

This inflammation and damage is acute pancreatitis.

How to recognize the symptoms of pancreatitis with gallstones

It may not be possible to tell if you have acute pancreatitis from gallstones based on your symptoms alone. However, if you have any of the symptoms listed below, you need to seek medical attention right away.

Here is the list of symptoms you need to look out for:

  1. Belly pain: The belly pain from acute pancreatitis is usually located in the mid-upper belly. It starts as a dull, burning pain, and intensifies within a few hours. The pain then starts to radiate to your back. It may also spread out to both sides in a belt-like fashion. Belly pain from acute pancreatitis gets significantly worse if you try to eat or drink anything.
  2. Previous right-sided belly pains: You may have had previous episodes of pain potentially caused by your gallstones. These gallstone pains are usually located in the upper right belly and are milder than the pain of acute pancreatitis. If you had this pain in the days or weeks prior to your pancreatitis pain, you need to think about pancreatitis from gallstones.
  3. Nausea and vomiting: You may have nausea and vomiting along with the belly pain. You will have a difficult time keeping anything down in the stomach.
  4. Dizziness and lightheadedness: You may get dizzy and lightheaded from dehydration as you keep throwing up without being able to keep anything down.
  5. Fast heart rate: With severe acute pancreatitis from gallstones, your heart rate may start to go up.
  6. Shortness of breath: Sometimes, the inflammation of gallstone pancreatitis may spread all the way up to the chest. You may have fluids in the lungs, potentially causing shortness of breath.
  7. Low blood pressure and collapse: You may go into shock when you have severe pancreatitis from gallstones.

You may find that some large corporate medical websites list jaundice as a symptom of pancreatitis from gallstones. However, the presence of jaundice with abdominal pain is a sign of another condition called bile duct obstruction. I have written a separate article on it. You can click on this link to understand what causes jaundice in that situation. Sometimes, gallstone pancreatitis and bile duct obstruction may happen together, but they are two separate conditions.

When you need to be hospitalized with gallstone pancreatitis

You will probably need hospitalization as soon as you are diagnosed with it. Because of the severity of the symptoms, most people with acute gallstone pancreatitis go to the ER. If you suspect you may have pancreatitis from gallstones, it is best to have someone drive you to the ER or call 911 and get yourself transported to the ER.

To diagnose gallstone pancreatitis in the ER, you will need blood tests as well as a CT scan or an ultrasound of your belly. From the blood tests, they can detect the digestive enzymes leaked by your pancreas. The higher the enzyme level in your blood, the more severe the inflammation and leakage. Once pancreatitis is detected, based on the increased levels of pancreatic enzymes in your blood, they will look for possible gallstones with an ultrasound or a CT scan based on whichever is available right away.

What to expect when hospitalized for gallstone pancreatitis

Acute pancreatitis from gallstones may be a mild illness or a severe life-threatening condition. There are no medications to treat acute pancreatitis. All you can do is allow the pancreas to rest and slowly go back to normal. Most of the care you receive when hospitalized for gallstone pancreatitis is supportive care. They simply support your body while your pancreas recovers. Here are several different types of supportive care you can expect to get in the hospital:

  1. Supporting blood volume: When you get dehydrated, your blood volume goes down. It is important to restore your blood volume to prevent your body from collapsing. Blood volume is supported by giving you plenty of IV fluids. People may need several liters of IV fluids per day with acute pancreatitis.
  2. Supporting your electrolytes: Electrolytes are the charged particles in your blood, such as sodium, potassium, magnesium, etc. It is important to keep these electrolytes well balanced. Electrolyte imbalance may, among other things, cause your heart rhythm to go haywire. You don’t want that.
  3. Nutritional support: In most patients with a mid-to-moderate disease, simply adding some glucose to the IV fluid may be enough to support their nutritional needs for a few days. These patients are expected to improve and be able to eat again in 4-5 days. In patients with a severe disease needing prolonged hospitalization, special nutritional support is needed.
  4. Supporting your breathing: Severe acute pancreatitis may make you short of breath. In mild cases, you may simply need some extra oxygen while you recover. In severe cases, you may need to be hooked up to a ventilator to help you breathe. You will be monitored closely in the ICU.

In addition to supportive care, another important treatment is to get rid of the gallbladder along with the gallstones that started the pancreatitis in the first place. Many people have gallstones without even knowing about them. If they don’t bother you, you can leave them alone. However, once they cause gallstone pancreatitis, they need to go out. Leaving them alone at this time may mean trouble. They can obstruct the flow of pancreatic enzymes again, and flare up your pancreatitis while you are recovering. A surgeon should perform the procedure to take out your gallbladder as soon as it is safe to do so. At the very least, it should happen before you are discharged from the hospital.

In conclusion, gallstones can lead to acute pancreatitis by blocking the flow of pancreatic enzymes. It is important to recognize the symptoms of acute pancreatitis and seek immediate medical care. The main treatment for acute pancreatitis is supportive care. It is important to get your gallbladder out as soon as possible once you have pancreatitis from gallstones.