gallstone pancreatitis

Gallstone pancreatitis refers to pancreatitis caused by gallstones, specifically distal choledocholithiasis. Gallstones are the cause for 35-40% of acute pancreatitis but this number has a wide regional variance.

Epidemiology

Gallstone pancreatitis has a higher incidence in women (compared to alcohol-induced pancreatitis, which has a higher incidence in men) .

Pathology

The exact pathophysiology of gallstone pancreatitis remains unclear. There are a number of theories :

• distal gallstone obstruction results in pancreatic duct obstruction, this results in increased pancreatic duct pressure and unregulated pancreatic enzyme activity
• acinar cell hyperstimulation has also been implicated
• infected bile reflux inducing pancreatic enzyme action

Treatment and prognosis

Treatment options vary but include:

• conservative management
• cholecystectomy
  • may be performed acutely during the index admission, or after a short interval after discharge
  • If gallstones are not treated, recurrence occurs in ~45% (range 32-61%)
• ERCP
  • Meta-analysis show no benefit of routine ERCP in gallstone pancreatitis in the absence of biliary obstruction or cholangitis

Siehe auch:

• Pankreatitis
• Akute Pankreatitis