Pancreatitis is inflammation of the pancreas gland. This gland is responsible for producing many of the enzymes that are essential for digesting food. The gland is part of the gut and sits in the upper part of the abdomen quite far back, overlying the front aspect of the spinal column. The digestive enzymes are made by the cells of the pancreas which is then collected in a series of tubes which run down into one main tube called the pancreatic duct. This enters the gut at the duodenum and in fact shares a common opening with the common bile duct. It is for this reason that gallstones can cause pancreatitis. 80% of causes of pancreatitis relate equally to either gallstones or alcohol. If a gallstone becomes displaced from the gall bladder and travels down the common bile duct it usually becomes impacted at the narrowed lower end of the latter just before it enters into the duodenum. Temporary occlusion of the common bile duct will result in biliary colic type symptoms (see separate section), but very occasionally it can result in ascending cholangitis rendering the patient potentially very sick. The patient also becomes jaundiced and all of this usually resolves promptly once the stone has been passed either spontaneously or via extraction. However even temporary occlusion of the pancreatic duct usually results in pancreatitis and this can be severe.
The typical symptoms of pancreatitis are severe upper abdominal pain with radiation through to the back. There is often associated constitutional upset in the form of nausea and vomiting. Admission to hospital is required for intravenous fluid replacement, analgesia, rest and supportive care. The toxins that are released into the blood stream from the inflamed pancreas can have a significant effect on the other organs of the body in particular the heart, lungs, liver and kidney. Rarely this can result in multi organ failure and death.
It is therefore important to exclude gallstones as a potential cause when patients present with pancreatitis and to treat these promptly. This entails extracting impacted stones using ERCP (Endoscopic Retrograde Cholodochopancreatogram). The definitive management is once again a laparoscopic cholecystectomy.