Chapter 41: Gallbladder and Pancreatic Disorders

Cholecystitis, characterized by acute inflammation of the gallbladder wall typically precipitated by cystic duct obstruction from gallstones, affects millions of Americans with increasing prevalence related to obesity trends. Cholesterol stones predominate in the general population, while pigmented stones associate with hemolytic conditions and hepatic disease. Patients present with characteristic right upper quadrant or epigastric pain exacerbated by fatty meals, accompanied by positive Murphy's sign on physical examination. Diagnostic confirmation relies on abdominal ultrasound for stone identification and hepatobiliary imaging for cystic duct patency assessment, with laboratory evidence of inflammation and hepatic enzyme elevation supporting diagnosis. Definitive treatment involves cholecystectomy following stabilization with fluid resuscitation and antimicrobial therapy. Acute pancreatitis results from premature activation of pancreatic enzymes within retroperitoneal tissue, most commonly triggered by biliary obstruction or alcohol consumption, manifesting as sudden epigastric pain radiating dorsally and improved by postural modification. Diagnostic confirmation requires markedly elevated serum amylase and lipase levels, with computed tomography employed for prognostic assessment and complication monitoring, while Ranson's criteria stratify disease severity. Management emphasizes aggressive hydration, analgesia, and nutritional support via enteral or parenteral routes in severe cases. Chronic pancreatitis represents an irreversible progressive fibrotic process predominantly caused by prolonged alcohol use, producing chronic pain, malabsorption with steatorrhea, and progressive endocrine insufficiency necessitating insulin therapy. Pancreatic cancer, predominantly adenocarcinoma of ductal origin, presents insidiously with vague symptoms including back pain and jaundice from ductal compression, typically at advanced stages limiting curative surgical options to the Whipple procedure for localized disease, with chemotherapy reserved for advanced presentations and poor overall prognosis.