Acute Biliary Pancreatitis

Abstract

Gallstones are the most common cause of acute pancreatitis (AP) and should always be investigated via abdominal ultrasound whenever a patient is suspected of having gallstone pancreatitis. Risk factors for developing gallstones include age >40, female sex, and obesity, and diagnosis can often be made via certain lab tests (elevated amylase, lipase, and AST/ALT) combined with an appropriate clinical history. Severe AP occurs when patients fail to improve clinically within 48–72 h despite appropriate IV hydration, after which an ERCP is strongly recommended. ERCP, or endoscopic retrograde cholangiopancreatography, is a specialized endoscopic technique used to study the bile ducts, pancreatic duct, and gallbladder. It allows physicians to remove gallstones, open a narrowed bile duct, and even insert stents into the duct to allow bile flow and prevent stone retention. This leads to reduced rates of organ failure, infection, and necrosis. ERCP is also recommended for patients with both AP and concurrent acute cholangitis (biliary tract infection) within 24 h of admission. ERCP is not without complications, mostly commonly causing post-ERCP-induced pancreatitis nearly 3–5% of the time. Perforation, bleeding, and sepsis are other serious yet less common complications. Importantly, all patients found to have gallstone pancreatitis are at increased risk for recurrent attacks and potential biliary sepsis and should be referred for cholecystectomy soon after recovery.