Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Key points
- Gallstones are common and often cause no trouble. Pain after fatty meals, or pain with fever or yellow eyes, needs assessment.
- A stone in the bile duct can cause jaundice, infection (cholangitis) or pancreatitis.
- Acute pancreatitis causes severe upper abdominal pain, often spreading to the back, and needs hospital care. Gallstones and alcohol are the commonest causes.
- ERCP and endoscopic ultrasound are endoscopic procedures used to diagnose and treat bile duct and pancreatic problems.
Overview
Bile made in the liver is stored in the gallbladder and released through the bile duct into the small bowel after meals. The pancreatic duct joins the bile duct near its end. Gallstones can form in the gallbladder and some travel into the bile duct, where they can block bile and pancreatic juice.
Biliary colic is pain from a stone briefly blocking the gallbladder outlet. Cholecystitis is inflammation of the gallbladder. Choledocholithiasis is a stone in the bile duct, and cholangitis is infection behind a blocked duct, which is an emergency.
Acute pancreatitis is sudden inflammation of the pancreas. Chronic pancreatitis is long-standing inflammation that can cause pain, poor digestion and diabetes. Pancreatic cysts and tumours are less common causes of symptoms; assessing them involves imaging, endoscopic ultrasound and specialist teams.
Causes and risk factors
- Gallstones: female sex, age, pregnancy, obesity, rapid weight loss, family history
- Acute pancreatitis: gallstones, alcohol, very high triglycerides, some medicines, after ERCP, and sometimes no cause is found
- Chronic pancreatitis: long-term alcohol, smoking, genetic and autoimmune causes, repeated acute attacks
Symptoms
- Pain in the upper right or upper middle abdomen, often after a fatty meal, lasting from 30 minutes to a few hours
- Pain spreading to the back or right shoulder, with nausea or vomiting
- In pancreatitis: severe, constant upper abdominal pain that may spread to the back, often with vomiting
- In chronic pancreatitis: ongoing pain, weight loss, and fatty, oily stools
When to seek urgent medical care
- Pain with fever or chills, yellow eyes or skin, dark urine or pale stools can mean infection or a blocked bile duct: urgent care
- Severe upper abdominal pain with vomiting, a fast heartbeat or fever: go to hospital
- Painless jaundice, unexplained weight loss or new diabetes in older adults need prompt assessment (most such cases are not cancer, but this must be checked)
In an emergency go to the nearest emergency department or call Rescue 1122.
How it is assessed
- Ultrasound scan and liver and pancreatic blood tests (including amylase or lipase and triglycerides)
- MRCP (a special MRI of the bile and pancreatic ducts), CT scan or endoscopic ultrasound when a duct stone or other problem is suspected
- ERCP is mainly used to treat (for example removing duct stones or placing a stent) rather than only to diagnose
Treatment
Gallbladder and bile duct
- Stones that cause no symptoms are often just watched
- When stones cause attacks or complications, removal of the gallbladder (cholecystectomy) is usually recommended
- Stones in the bile duct can often be removed endoscopically (ERCP)
Pancreatitis
- Acute pancreatitis is treated in hospital with fluids, pain relief, early nutrition and treatment of the cause (for example gallstone removal)
- Avoid alcohol and heavy fatty meals during recovery
- Chronic pancreatitis needs long-term care: pain control, enzyme replacement when needed, stopping alcohol and tobacco, and checking for diabetes
What you can do
- Eat smaller, lower-fat meals if fatty meals trigger pain, but do not rely on diet to dissolve stones
- Avoid alcohol if you have had pancreatitis, and stop smoking
- Lose weight gradually; avoid crash diets, which can form gallstones
- Ask about the risks and benefits of any procedure, including ERCP, before you consent
Common questions
Do I need my gallbladder removed if I have stones?
Not if the stones cause no symptoms. When stones cause pain attacks or complications, removal is usually advised. Your doctor and surgeon will discuss this with you.
What is ERCP?
ERCP is a procedure that combines an endoscope and X-ray to look at and treat the bile and pancreatic ducts, for example to remove bile duct stones or place a stent. It carries risks, including pancreatitis and bleeding, which your doctor will explain.
Will I get pancreatitis again?
If the cause is removed, for example by removing gallstones or avoiding alcohol, the risk of another attack falls substantially. Your doctor will advise on prevention.
اردو خلاصہ
پتے کی پتھری بہت عام ہے اور اکثر کوئی علامت نہیں ہوتی۔ چکنائی والے کھانے کے بعد دائیں اوپری پیٹ میں درد ہو تو معائنہ کروائیں۔ بخار، یرقان یا گہرا پیشاب کے ساتھ درد پتے کی نالی کی رکاوٹ یا انفیکشن کی علامت ہو سکتی ہے، جس کے لیے فوری علاج ضروری ہے۔
لبلبے کی شدید سوزش میں پیٹ کے اوپری حصے میں شدید درد ہوتا ہے جو پیٹھ تک جا سکتا ہے اور اکثر قے ہوتی ہے؛ اس کے لیے ہسپتال میں علاج ضروری ہے۔ اس کی عام وجوہات پتھری اور الکحل ہیں۔ پتے کی نالی کی پتھری ERCP سے نکالی جا سکتی ہے۔
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This page gives general information prepared for Dr Usman Naeem and is not personal medical advice. See the medical disclaimer.