Cholecystitis vs Pancreatitis: Gallbladder vs Pancreas — Pain, Labs, Diet
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.
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- Gallbladder inflammation, ~90% 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 pain radiating to right shoulder
- ★Cullen's/Grey Turner's sign (bruising)
- Epigastric pain boring to the 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
- NPO, then early enteral feeding
- NG tube if vomiting / ileus
- IV fluid resuscitation
- Pain control
- Lap cholecystectomy, ideally < 72 hr
- Supportive care
- Surgery only for complications
- Low-fat diet
- Avoid gas-forming foods
- Low-fat diet
- Avoid all alcohol
- Pancreatic enzymes with meals if needed
- ★Charcot's triad: fever, jaundice, RUQ pain
- Suspect ascending cholangitis
- Hypocalcemia: tetany, Chvostek/Trousseau
- Shock, ARDS, organ failure
- CBD obstruction, obstructive jaundice
- Ascending cholangitis
- Hemorrhagic pancreatitis, pseudocyst
- Hypocalcemia from fat saponification
Cholecystitis
- Gallbladder inflammation, ~90% 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 pain radiating to right shoulder
Acute Pancreatitis
- ★Cullen's/Grey Turner's sign (bruising)
- Epigastric pain boring to the 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
Acute Pancreatitis
- NPO, then early enteral feeding
- NG tube if vomiting / ileus
- IV fluid resuscitation
- Pain control
Cholecystitis
- Lap cholecystectomy, ideally < 72 hr
Acute Pancreatitis
- Supportive care
- Surgery only for complications
Cholecystitis
- Low-fat diet
- Avoid gas-forming foods
Acute Pancreatitis
- Low-fat diet
- Avoid all alcohol
- Pancreatic enzymes with meals if needed
Cholecystitis
- ★Charcot's triad: fever, jaundice, RUQ pain
- Suspect ascending cholangitis
Acute Pancreatitis
- Hypocalcemia: tetany, Chvostek/Trousseau
- Shock, ARDS, organ failure
Cholecystitis
- CBD obstruction, obstructive jaundice
- Ascending cholangitis
Acute Pancreatitis
- Hemorrhagic pancreatitis, pseudocyst
- Hypocalcemia from fat saponification
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Murphy's sign + ↑ALP = gallbladder; boring-to-back pain + ↑lipase = pancreas.
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