Areas of Expertise
Biliary and Pancreatic Diseases
The gallbladder, bile ducts and pancreas are key organs of digestion. This section gives an overview of gallstones, bile duct infection, pancreatitis and pancreatic cysts. The information is general; diagnosis and treatment require evaluation by a physician.
01
Gallstones and biliary colic
Gallstones stay silent in many people but cause painful attacks in some.
The gallbladder is a small organ that stores bile made by the liver. Some substances in bile can settle and form sand or stones. Most gallstones cause no symptoms. If a stone briefly blocks the gallbladder outlet, a pain attack called biliary colic occurs. Stones can also lead to gallbladder inflammation or other bile duct problems. They are more common in women, older adults, people with excess weight and those with a family history.
Symptoms
- Sudden pain in the upper right or upper middle abdomen
- Pain spreading to the right shoulder or back
- Pain that often begins after a meal
- Nausea and vomiting
- Pain that lasts a few hours and settles on its own
When to see a doctor
- If you have repeated pain attacks
- If the pain lasts longer than a few hours
- If fever or shaking chills accompany the pain
- If you notice yellowing of the eyes or skin
- If symptoms change in someone with known gallstones
How is it diagnosed?
Diagnosis relies on a physician’s examination and an abdominal ultrasound. Blood tests help assess the liver, bile ducts and inflammation. Further imaging is added if needed. For stones found by chance that cause no symptoms, follow-up alone is often enough.
Treatment and lifestyle
- Stones that cause no symptoms are often simply monitored
- For symptomatic stones, surgical removal of the gallbladder is a common approach
- The timing and method of surgery are decided together with the physician
- A physician decides which medicines to use during a pain attack
- After gallbladder removal, most people return to a normal diet
- Follow-up advice after an attack should be heeded
LifestyleEating a balanced diet, keeping a healthy weight and avoiding very rapid weight loss may help lower the risk of stones, alongside medical care.
03
Acute pancreatitis
Acute pancreatitis is a sudden inflammation of the pancreas and needs hospital evaluation.
The pancreas is an organ that makes digestive enzymes and hormones such as insulin. In acute pancreatitis, these enzymes become active too early inside the organ and cause inflammation. The most common causes are gallstones and alcohol. High triglyceride levels, some medicines and procedures can also cause it. Sometimes no cause is found. The illness may be mild, but in some people it becomes severe and affects other organs.
Symptoms
- Severe, constant pain in the upper abdomen spreading to the back
- Nausea and repeated vomiting
- Abdominal bloating and tenderness to touch
- Fever and a racing heart
- Loss of appetite
When to see a doctor
- Go to an emergency department without delay for severe abdominal pain lasting hours
- If constant vomiting and inability to keep fluids down accompany the pain
- If fever, shortness of breath or a racing heart develops
- If jaundice is also present
- If you have had pancreatitis before and the pain returns
How is it diagnosed?
Diagnosis is made from typical abdominal pain and raised pancreatic enzymes (amylase, lipase) in the blood. Imaging such as computed tomography is added if needed. Ultrasound is used to look for gallstones. Tests such as blood fats and calcium are also checked to find the cause.
Treatment and lifestyle
- Treatment is usually in the hospital with intravenous fluids and pain control
- Patients are closely monitored; severe cases may need intensive care
- In mild cases, eating by mouth is started early as soon as it is tolerated
- If gallstones are the cause, gallbladder removal is planned; if there is a blocked bile duct or an infection (cholangitis), endoscopic retrograde cholangiopancreatography (ERCP) may also be needed
- Triggers such as alcohol and any medicine responsible are removed
- If triglycerides are high, treatment to lower them is given
LifestyleAvoiding alcohol, quitting smoking and keeping triglycerides under control help reduce the risk of another attack, in addition to medical care.
04
Chronic pancreatitis
Chronic pancreatitis is lasting damage to the pancreas caused by long-term inflammation.
In chronic pancreatitis, repeated or ongoing inflammation causes lasting structural changes in the pancreas. Over time, the organ’s production of digestive enzymes and insulin may fall. Alcohol is one of the most important causes. Smoking is also a major risk for developing and worsening the disease. Inherited, autoimmune and bile duct-related causes also exist. In some people no cause is found.
Symptoms
- Recurrent or constant upper abdominal pain spreading to the back
- Pain that worsens after eating
- Unintentional weight loss
- Greasy, foul-smelling, floating stools
- Bloating and gas
- Diabetes developing over time
When to see a doctor
- If you have had upper abdominal pain for weeks or it keeps returning
- If you are losing weight without trying
- If you notice greasy, foul-smelling stools
- If pain worsens or jaundice develops in known disease
- If new diabetes and weight loss appear together
How is it diagnosed?
Diagnosis is based on symptoms, risk history and imaging. Computed tomography, magnetic resonance imaging or endoscopic ultrasound can show changes in the pancreas. Stool tests and blood sugar help assess digestive and hormone function. Endoscopic ultrasound is described in the advanced endoscopy section.
Treatment and lifestyle
- Stopping alcohol and smoking completely is the foundation of treatment
- Pain is managed with a stepwise plan made by the physician
- For poor digestion, pancreatic enzyme supplements are used under medical supervision
- If diabetes develops, regular monitoring and treatment are needed
- In selected people, endoscopic or surgical procedures may be considered
- Nutritional support and monitoring for vitamin deficiencies are important
LifestyleQuitting alcohol and smoking and eating a balanced diet may help ease symptoms and slow disease progression, alongside medical treatment.
05
Pancreatic cysts
Most pancreatic cysts are found by chance; some types need regular follow-up.
A pancreatic cyst is a fluid-filled sac in the pancreas. It is often found by chance during imaging done for another reason. Not all cysts are cancer, and many remain harmless. However, some types can change over time. This is why identifying the type of cyst and, when needed, following it regularly is important. Pseudocysts that develop after pancreatitis are a separate group.
Symptoms
- Most cysts cause no symptoms
- Pain or discomfort in the upper abdomen
- Nausea and a feeling of fullness when a large cyst presses on nearby organs
- Jaundice if the cyst presses on the bile duct
- Unintentional weight loss
- Repeated attacks of pancreatitis
When to see a doctor
- If a pancreatic cyst is found on imaging, ask for a specialist evaluation
- If jaundice, weight loss or new abdominal pain develops
- If you have an attack of pancreatitis
- Do not skip the follow-up imaging that is recommended
- Tell your physician if there is pancreatic cancer in your family
How is it diagnosed?
The type of cyst is assessed with magnetic resonance imaging, computed tomography and, when needed, endoscopic ultrasound. In some cases, testing the cyst fluid helps. These methods are described in the advanced endoscopy section. The physician sets the follow-up interval based on the size and features of the cyst.
Treatment and lifestyle
- Low-risk cysts are mostly followed with regular imaging
- The follow-up interval depends on the type and features of the cyst
- If concerning features appear, further tests or surgical evaluation are done
- Treatment of cysts that cause symptoms or grow is planned with the physician
- Pseudocysts can be treated endoscopically or surgically when needed
- Follow-up decisions are made according to guidelines and tailored to the person
LifestyleAvoiding smoking and alcohol helps protect pancreatic health, alongside follow-up.
