Most disease of the gall-bladder is due to stones, apart from the uncommon occasions when Ascaris invades it. Such is the lifestyle of most of your patients that you probably won't see it very often. In Africa it is unusual, but it is commoner in Northern India and Tibet. Disease of the pancreas is also uncommon in much of Africa, but calcified chronic pancreatitis and carcinoma of the pancreas are not uncommon in India.

Many patients are found at postmortem to have gall-stones which have caused no symptoms. Stones may however obstruct the common bile-duct and cause biliary colic, or obstructive jaundice. They can promote infection of the gall-bladder and cause acute or chronic cholecystitis. They can also promote infection of the pancreas and cause pancreatitis. You can treat acute cholecystitis non-operatively, or if this fails, you can drain a patient's gall-bladder by doing a cholecystostomy. If he has chronic cholecystitis, you may sometimes be able to remove his gall-bladder. But if he has obstructive jaundice due to stones in his common duct, you should refer him to an expert. If he has obstructive jaundice due to carcinoma of the head of his pancreas, you may be able to relieve his symptoms by making an opening between his gall-bladder and his jejunum[md]a cholecysto-jejunostomy (13-6).

You can treat acute pancreatitis (13.9), a pancreatic abscess (5.10b), and drain a pancreatic pseudocyst (13.10). There are also a few occasions when splenectomy is indicated, other than for trauma (13.11).