Cholecystitis vs Pancreatitis
Both conditions slam the client with severe upper abdominal pain after a fatty meal, and both elevate WBCs. Mixing up the pain pattern or grabbing the wrong lab value leads you to the wrong diagnosis — and on the NCLEX, the wrong intervention. The distinction lives in where the pain radiates and which enzyme spikes.
Side-by-side comparison
- Gallbladder inflammation, usually gallstones
- 5 F's: Female, Forty, Fat, Fertile, Fair
- Pancreatic autodigestion by enzymes
- Alcohol and gallstones (~80%)
- ★Murphy's sign: inspiratory arrest on RUQ
- RUQ colicky pain → right shoulder/scapula
- ★Cullen's (periumbilical)/Grey Turner's (flank) bruise
- Epigastric boring pain → straight to back
- ↑ ALP, ↑ direct bilirubin if CBD stone
- RUQ ultrasound: stones, wall thickening
- ★↑ Lipase: most specific, stays up longer
- ↑ Amylase rises first; CT for necrosis
- NPO, then clear liquids as pain subsides
- Pain control, advance to low-fat
- NPO, then early enteral feeding
- NG tube if vomiting / ileus
- Aggressive IV fluids, pain control
- Laparoscopic cholecystectomy, often <72 hr
- Supportive care; surgery only for complications
- Permanent low-fat diet (<25 g fat/day)
- Avoid gas-forming foods
- Low-fat small frequent meals
- Absolute alcohol avoidance
- May need pancreatic enzyme supplements
- ★Charcot's triad: fever, jaundice, RUQ pain
- Suspect ascending cholangitis
- Hypocalcemia: tetany, Chvostek/Trousseau
- SIRS / sepsis, hemodynamic instability
- Bile duct obstruction, obstructive jaundice
- Ascending cholangitis
- Hemorrhagic pancreatitis, pseudocyst
- Hypocalcemia from fat saponification
Cholecystitis
- Gallbladder inflammation, usually gallstones
- 5 F's: Female, Forty, Fat, Fertile, Fair
Acute Pancreatitis
- Pancreatic autodigestion by enzymes
- Alcohol and gallstones (~80%)
Cholecystitis
- ★Murphy's sign: inspiratory arrest on RUQ
- RUQ colicky pain → right shoulder/scapula
Acute Pancreatitis
- ★Cullen's (periumbilical)/Grey Turner's (flank) bruise
- Epigastric boring pain → straight to back
Cholecystitis
- ↑ ALP, ↑ direct bilirubin if CBD stone
- RUQ ultrasound: stones, wall thickening
Acute Pancreatitis
- ★↑ Lipase: most specific, stays up longer
- ↑ Amylase rises first; CT for necrosis
Cholecystitis
- NPO, then clear liquids as pain subsides
- Pain control, advance to low-fat
Acute Pancreatitis
- NPO, then early enteral feeding
- NG tube if vomiting / ileus
- Aggressive IV fluids, pain control
Cholecystitis
- Laparoscopic cholecystectomy, often <72 hr
Acute Pancreatitis
- Supportive care; surgery only for complications
Cholecystitis
- Permanent low-fat diet (<25 g fat/day)
- Avoid gas-forming foods
Acute Pancreatitis
- Low-fat small frequent meals
- Absolute alcohol avoidance
- May need pancreatic enzyme supplements
Cholecystitis
- ★Charcot's triad: fever, jaundice, RUQ pain
- Suspect ascending cholangitis
Acute Pancreatitis
- Hypocalcemia: tetany, Chvostek/Trousseau
- SIRS / sepsis, hemodynamic instability
Cholecystitis
- Bile duct obstruction, obstructive jaundice
- Ascending cholangitis
Acute Pancreatitis
- Hemorrhagic pancreatitis, pseudocyst
- Hypocalcemia from fat saponification
★ marks the fact that sets a column apart.
Clinical Pearl
Murphy's sign + ↑ALP = gallbladder; boring-to-back pain + ↑lipase = pancreas.
Play this as a game — free
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