History is clearly gallbladder (โbiliary colicโ). Now cholecystitis, so evaluate with ultrasound. Minimal lipase bumps can be seen with other GI and biliary issues, but also note that gallstones can also cause pancreatitis, so itโs certainly possible for her to also have that brewing. If you suspect gallbladder/biliary issues, always start with US.
osler_weber_renduPrevious episodes sound like biliary colic. This episode with more severe and longer-lasting pain with elevated Amylase Lipase sounds more like pancreatitis, doesn't it?+1
mmizell@osler_weber_rendu
I totally agree with the acute change in symptoms and elevated amylase and lipase causing suspicion for pancreatitis. But, now I feel like they would have given us radiation and positional pain characteristics with pancreatitis (radiates to the back, better on bending forward/worse on leaning back), and the lipase would have been significantly higher (>3x normal). Once I reviewed I also added choledocholithasis to my ddx because even though she doesn't have jaundice, that would much better explain the increase in amylase, lipase, AST, and ALT imo. Regardless, for any of the acute gallbladder diseases, RUQ US is the next step before moving to ERCP or MRCP.
Other pearl that I didn't know: Amylase can be elevated with gallbladder inflammation, and isn't specific for pancreatitis.
Gallbladder:
https://onlinemeded.org/spa/gastroenterology/gallbladder/acquire
Pancreas:
https://onlinemeded.org/spa/gastroenterology/pancreatitis/acquire+2
submitted by โbwdc(697)
History is clearly gallbladder (โbiliary colicโ). Now cholecystitis, so evaluate with ultrasound. Minimal lipase bumps can be seen with other GI and biliary issues, but also note that gallstones can also cause pancreatitis, so itโs certainly possible for her to also have that brewing. If you suspect gallbladder/biliary issues, always start with US.