Pancreatic stones - Causes, Symptoms, Incidence, Complications, Treatment & Prevention

What are pancreatic stones?

Pancreatic stones are often medically called pancreatolithiasis or pancreatic calculi (PC). Pancreatolithiasis is the consequence of chronic pancreatitis and is commonly seen in parenchyma, side branches, and the common main ducts of the pancreas. Calculi are the product, regardless of how chronic pancreatitis originated. Pancreatic calculi have an inner nidus that is encircled by consecutive calcium carbonate layers.

Pancreatic stones are composed of hardened digestive fluids, like biliary matter. Pancreatic calculi, however, are often formed of fragments of calcium carbonate that have solidified out of pancreatic enzymes and become lodged in the duct connecting the pancreas to the small intestine. 

Composition of pancreatic stones

Pancreatic stones are composed of a calcium carbonate crystalline lattice embedded within a gel-like matrix comprising multiple fibrillar proteins and polysaccharides.

Incidence of pancreatic stones

Classification of pancreatic calculi 

Pancreatic calculi or pancreatic stones are classified based on the type, number of stones and location.

Based on the type, the pancreatic calculi are:

• Radio opaque
• Radiolucent 
• Mixed 

Based on the number, the pancreatic calculi are:

• Single or
• Multiple 

Based on the location, the pancreatic calculi may occur at:

• Main pancreatic duct (MPD)
• Side branches or in the pancreatic parenchyma 
• Head, body or tail regions of the pancreas 
  

Symptoms of pancreatic stones

Pancreas stones can cause a variety of symptoms, based on the type, number and location, including:

• Severe abdominal pain in the upper left or middle abdomen, radiates to the back or chest
• Sudden and intense pain may last for several hours or days
• Jaundice (yellowing of the skin and eyes)
• Nausea & vomiting
• Fever & Chills
• Difficulty digesting food
• Unwanted weight loss
• Irregular heartbeat (arrhythmia)
• Dehydration
• Low blood pressure

Stone blockage in the pancreatic duct leads to severe abdominal pain; the pain might be seen in the upper part of the stomach or radiate to the chest or back region. In addition, pancreatic stone results in pancreatitis (inflammation of the pancreas), which induces fever, nausea, chills, vomiting and more.

These symptoms might be constant or intermittent. However, the onset of the occurrence is sudden. Some uncommon symptoms, such as jaundice, light-coloured stools, dark urine, fast breathing (tachypnoea), and rapid heart rate (tachycardia), are seen in occasional cases.

NOTE: If any of the above signs are seen, it's crucial to consult the gastroenterologist as soon as possible. If pancreatic stones are not treated immediately, they can result in serious complications.

It's crucial to remember that not all people with pancreatic stones will exhibit the above symptoms. In certain circumstances, imaging examinations for other medical issues may unintentionally discover pancreatic stones.

Pancreatic stones causes

The exact cause of pancreas stones is not clearly understood, but they are contemplated to form when substances in pancreatic juice such as calcium carbonate, protein, bilirubin solidify. 

Pancreas stones are more commonly found in people who have:

• A history of gallstones (cholelithiasis)
• Chronic pancreatitis
• High levels of triglycerides or calcium in the blood
• Certain genetic disorders or inherited diseases

Most pancreatic stones are due to gallstones; the gallstones travel from the gall bladder to the common biliary duct and cause obstruction in the biliary duct, thus resulting in gall stone pancreatitis and stone formation. The blockage of the common bile duct results in the backup of bile into the pancreatic duct, resulting in stone formation.

The causes of pancreatic stones are as follows:

• The high levels of calcium deposition in the pancreatic duct as a result of calcium carbonate fragments that have solidified from pancreatic enzymes result in the formation of pancreatic stones. Also, high calcium levels due to hyperparathyroidism might be prone to pancreatic stones.
• Sliding or travelling of gall or biliary stones to the pancreatic duct (blockage of the biliary duct by gall stones).

Risk factors for pancreatic stones

Pancreatic stones are the consequence of chronic pancreatitis. However, not all pancreatic stones are of pancreatic origin; the following factors might have developed some of them: 

• Alcohol abuse: Studies have shown that increased alcohol consumption (5 drinks per day) increases the risk of chronic pancreatitis. Chronic pancreatitis patients associated with alcohol show decreased pancreatic stone protein secretion, resulting in calcium carbonate crystallisation and deposition, leading to stone formation. 
• Smoking: Nicotine induces structural and functional changes in the exocrine pancreas. 
• Gene mutations: SPINK1 gene (pancreatic secretory trypsin inhibitor gene) mutations can increase the risk of chronic pancreatitis, which plays a major role in pancreatic stones. 
• Autoimmune diseases: In diseases like autoimmune pancreatitis (AIP), the levels of immunoglobulin G4 (IgG4) are elevated; this phenomenon has a high risk of stone formation. 
• Metabolic disturbances: Hypertriglyceridemia, hypercalcemia (due to hyperparathyroidism), diabetes mellitus, porphyria, and Wilson's disease tend to increase the risk of pancreatitis and stone formation. 
• Environmental conditions: Other factors such as obesity and a sedentary lifestyle increase individuals' risk of stone formation.
• Anatomical abnormalities: Chronic obstructive pancreatitis and stone evolution might result from ductal blockage caused by inflammatory strictures or malignancies. 
• Cystic fibrosis: In cystic fibrosis conditions, the role of cystic fibrosis transmembrane conductance regulator (CFTR) Cl- channel is impaired. CTFR plays a significant role in pancreatic ductal secretory functions. 
  

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