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Sophia Aina
Funcfions of Anatomy and Physiology
Dr. Williams
1/6/14
Pancreafifis and Gallstones
The relafion between gallstones and acute pancreafifis is very common. Numerous studies or
invesfigafions have shown changes associated with acute pancreafifis are common in gallstone pafients.
Although it seems that gallstones might be a cause of acute pancreafifis according to these &ndings,
clinical and experimental studies are sfill needed for con&rmafion, and further studies are required to
determine the mechanisms involved.
The pancreas is a very vital organ in the body. It’s a large gland located behind the stomach and
next to the &rst secfion of the small intesfine, as seen in Figure 1-1. The pancreas is about 6 inches long
(WEB MD LCC). The head of the pancreas is on the right side of the abdomen and is connected to the
&rst secfion of the small of the intesfine through a small tube, called the pancreafic duct (WEB MD LCC).
The pancreas has two primary funcfions (WEB MD LCC). “To secrete powerful digesfive enzymes into the
small intesfine to aid the digesfion of carbohydrates, proteins, and fats” (WEB MD LCC). The other
funcfion of the pancreas is to release hormones insulin and glucagon (WEB MD LCC). These hormones
are involved in blood glucose metabolism, regulafing how the body stores and uses food energy (WEB
MD LCC).
Pancreafifis is a disease in which the pancreas becomes in7amed. Pancreafifis can be caused by
a number of things, such as gall stones, heavy drinking…etc. Pancreafic damage occurs when digesfive
enzymes are acfivated before they are secreted into the &rst secfion of the small intesfine and can begin
a:acking the pancreas. If pancreafifis is caused by gallstones, then it is very common for one of the
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stones to move into the common bile duct and block o< the 7ow to the pancreas, which will cause the
pancreas to become in7amed.
There are two types of in7ammafion that can occur within the pancreas. Chronic pancreafifis is a
progressive disease with complicafions, such as diabetes and malabsorpfion, which usually lead to
increased morbidity and social problems. Chronic pancreafifis is usually developed increasingly, and
characterized by &bro genesis and impairment of pancreafic funcfion. Acute pancreafifis is a sudden
in7ammafion that occurs over a short period of fime. In the majority of cases, acute pancreafifis is
caused by gallstones or heavy alcohol use. In 30% of people with acute pancreafifis, the cause is
unknown (WEB MD LCC).
The severity of acute pancreafifis may range from mild abdominal discomfort to a severe, life-
threatening illness. However, the majority of people with acute pancreafifis recover completely aBer
receiving the appropriate treatment. In very severe cases, acute pancreafifis can result in bleeding into
the gland, serious fissue damage, infecfion, and cyst formafion. Severe pancreafifis can also create life
threatening condifions which can harm other vital organs, such as the heart, lungs, and kidneys (WEB
MD LCC).
The gallbladder is a small organ where bile is stored, before it is released into the small intesfine.
It is a hollow system that sits just beneath the liver. The gallbladder can be divided into three di<erent
secfions; fundus, body and neck. The neck tapers and connects to the biliary tree via the cysfic duct,
which then joins the common hepafic duct to become the common bile duct. At the neck of the
gallbladder, there is a mucosal fold called the Hartmann’s pouch. This is where gallstones commonly get
stuck and cause the most damage.
The role the gallbladder plays in digesfion is a complicated process. The process helps to explain
the role that bile plays in how we digest food in the small intesfine. “The primary funcfion of the
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gallbladder is to store and concentrate bile, a yellow-brown liquid produced by the liver” (“Gallbladder”).
Since the gallbladder is part of the biliary tract, it serves as a storage unit for bile that is not immediately
used for digesfion (“Gallbladder”). The gallbladder is also made up of di<erent types of connecfive
fissue. The absorpfive epithelial lining concentrates the stored bile (“Gallbladder”). When food enters
the small intesfine, a hormone called cholecystokinin is released. This hormone is the trigger that signals
the gallbladder to contract and secrete the stored bile into the small intesfine through the common bile
duct (“Gallbladder”). The release of the bile is the main role in digesfion. “The bile helps the digesfive
process by emulsifying fats and neutralizing acids in parfially digested food,” (“Gallbladder”).
There are many diseases that result from damage to or from the gallbladder. Gallstones are one
thing that can happen. Along with helping aid in digesfion, bile also plays a role in the formafion of
gallstones. According to healthline.com, “an excess of cholesterol, bilirubin or bile salts can cause
gallstones to form,” (“Gallbladder”). “Gallstones are small, hard deposits inside the gallbladder that are
formed when the stored bile crystallizes,” (“Gallbladder”).
Since the pancreas and the gallbladder are within the same region of the abdominal cavity, there
are many diseases that a<ect both organs at once or one aBer the other. Due to communicafion
between the organs through the common bile duct, damage to the pancreas could cause a problem with
the gallbladder and vice versa. Pancreafifis and Gallstones are only two diseases that can a<ect both
organs at the same fime. Gallstones are much more diEcult to diagnose than pancreafifis. OBen fimes, a
person who is su<ering from gallstones will rarely feel any symptoms unfil the gallstones reach a certain
size or they move and obstruct the bile duct, (“Gallbladder”). Pancreafifis is much more common to
diagnose and can be done by geGng a simple blood test that checks your enzyme levels. People who
su<er from pancreafifis oBen experience severe epigastric abdominal pain, nausea and vomifing, and
many other symptoms.
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There have been many cases of pancreafifis due to gallstones reported in the United States, but
one case interested me in parficular. Typically, pancreafifis is found in elder pafients, but the focus of this
case study is 15 year old, teenager Rose Morgan. She was diagnosed with pancreafifis caused by
gallstones. Rose had all the typical symptoms of someone with pancreafifis. She su<ered from epigastric
abdominal pain, nausea and vomifing, fafigue and weakness.
Rose Morgan is a 20 year old Caucasian female of Middle Eastern decent. She has one sibling
and two parents in her immediate family. She is a student in pharmacy school and hopes to become a
pharmacist one day. Being from Middle Eastern decent, Rose grew up with a big family. She has a great
relafionship with all her cousins and they support her in everything she does. She loves reading,
watching movies, wrifing and generally sur&ng the web. She doesn’t have any history of drinking,
smoking or use of recreafional drug. She was hospitalized when she was 15 years old for acute
pancreafifis caused by gallstones. She spent ten days in intensive care, followed by surgery for removal
of gallstones and inserfion of drains into the pseudo cyst, which eventually formed on the pancreas.
Prior to discharge she had progressed to a soB, low-bland, low fat diet. Had all the drains worked, she
wouldn’t have had most of the complicafions she had.
She was 15 years old when she &rst noficed something was wrong. It was a hot, August summer
day when she felt symptoms for the &rst fime. She was celebrafing her 15th birthday at a water park with
her family and her aunt’s family. They had been there for two days already, when her birthday came
around. She was in the pool swimming with her dad and generally having fun when she felt cramping.
Her &rst thought, it was just swimming cramps, so her dad led her to the lawn chair to rest. Within the
day, the cramps came and went. Her dad, having working in the hospital, went with the life guard and
got her some Tylenol and some Pepcid for her stomach. Their thought was maybe she ate something
spicy & had cramps from that. They didn’t think anything of it.
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With her cramps coming and going, and not having any other symptoms, Rose just went along
with her day to day life. She was a sophomore in high school and had plenty of school work to keep her
busy. One school night, around 10:00 pm, Rose came down from her room and told her parents that she
was in severe pain. Her parents knew there was something more going on, so they took her to the
emergency room at General Hospital. Due to the fact that her brother was home alone, she told her dad
to go back home and be with him, while her mom stayed with her. ABer waifing for what seemed like
forever, when in reality it was more like thirty minutes, she was led back into an exam room. She sat on
the bed Indian-style, with her legs crossed in front of her hugging a pillow to her stomach to ease some
of the pain.
Her mom, Anna stood next to the bed and rubbed her back for comfort. She felt so helpless, just
standing there watching her daughter in so much pain. She wanted to do something to help, so she did
the only thing she knew how to do and comforted her the best she could. The nurse came in, took her
vitals, asked all the pre-exam quesfions she needed to ask and then instructed her to wait for the doctor
and that he would be right in. ABer a couple of minutes of waifing, the resident came in, followed by the
doctor. By the fime the doctor and resident came in, Rose’s pain had died down a li:le and wasn’t so
intense. They didn’t want to give her any pain medicafion, because they didn’t know what was wrong
with her. That wasn’t siGng well with Rose and her mom. Anna worked at General Hospital, so she
wanted her daughter treated the way the hospital pracficed. She wanted to relieve her daughter of pain
she had and wanted her to feel be:er.
Once the doctor conducted his IPAP (inspecfion, palpafion, auscultafion, and percussion) exam,
he confinued to ask Rose and Anna quesfions about her medical history and her family’s medical history.
Her grandfather died from colon cancer and had diabetes. Her grandmother had gallstones and had her
gallbladder surgically removed. Anna had kidney stones, but was able to pass them without medical
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assistance. On her father Sami’s side, high triglycerides and high cholesterol. Unfil that point in her life,
she has had no medical complicafions. She was a normal, healthy teenage girl. ABer reviewing all the
history, he had learned about Rose and her family history, he came to the conclusion that Rose was
su<ering acid re7ux disease. Rose and Anna let out a breath of relief. They were glad it wasn’t anything
more serious. Dr. Greene prescribed her some Prilosec OCT for her acid re7ux. He told her to take two
tablets daily half an hour before she eats and that should help with the pain. Rose and Anna went home
relieved that they &nally had an answer for her symptoms.
Rose confinued going to school and going on with her day to day while taking her medicafion.
She was feeling great. She felt like she never had cramps at all. It wasn’t unfil September that she felt the
cramps again. Only this fime, her family started noficing that she was more fafigued. She had no energy
for anything anymore. One day in September, she was siGng in her &rst class at school, talking with her
friends when she suddenly experienced an a:ack. Her friends noficed the changes right away because
she instantly paled and became real quiet. She sat through whole class really quiet, pale and holding her
stomach. Rose didn’t like being the center of a:enfion, so she just dealt with it. She went on with her
day in school like nothing was wrong. When her dad picked her up later that day, he noficed something
was di<erent. She walked to the car a li:le slower than usual and her friends were watching her with
worried looks on their faces. She put her bag pack in the backseat and got in the car. “What’s wrong?”
her dad asked. “I have cramps. I had them all day at school” she replied. He nodded and drove home.
The situafion stayed like that all through September and through the beginning of October. With
her coming home from school in pain, and not even having enough energy to &nish her homework. Her
family, friends and teachers started noficing the changes in her behavior. They all became concerned.
Rose tried to down play it the best she could. Whenever she got an a:ack, she just sat Indian-style and
hugged a pillow to her stomach. OBen fimes, she slept that way as well. It was the only relief she could
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get from her pain. With trips back and forth to the emergency room, Rose was geGng the same answer
& result of acid re7ux. She was prescribed every anfi-acid known to man and none of them worked for
more than a few weeks. Her family was geGng frustrated. Rose didn’t really care anymore. She was
generally fired and weak. She didn’t have the energy to care anymore. She just wanted the pain to stop.
One morning in October Rose woke up an hour before she normally would and got dressed for
school. She went to private all-girl, catholic high school, so she had a uniform that was required. Once
she was dressed and &nished her morning necessifies, she quietly made her way to the kitchen. Her dad
already went to work and her mom was sfill sleeping so she tried to be quiet. Her dad works as an
anesthesia technician at Mercy West and her mom as a supervisor for the Neurological Insfitute at
General Hospital. Her dad had to be at work before the operafing rooms opened so she knew he
wouldn’t be down there. She made herself some tea and sat at the kitchen table. Before her tea was
