Differential Diagnosis
- Single most likely diagnosis
- Acute pancreatitis: The patient's symptoms of epigastric pain, nausea, and vomiting after attempting to drink, along with the elevated lipase level (2000) and CT findings of acute interstitial pancreatitis, strongly support this diagnosis. The presence of a gallstone in the gallbladder neck also suggests a possible gallstone pancreatitis.
- Other Likely diagnoses
- Gallstone disease: Although the ultrasound shows a stone in the gallbladder neck without evidence of cholecystitis, the stone could still be causing pancreatitis. The patient's symptoms and lab results are more indicative of pancreatitis, but gallstone disease is a related condition that should be considered.
- Alcoholic pancreatitis: Given the patient's age (20) and the fact that symptoms occurred after attempting to drink, alcoholic pancreatitis is a possible diagnosis. However, the presence of a gallstone and the lack of information about the patient's drinking habits make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Biliary obstruction: Although the ultrasound does not show evidence of cholecystitis, a stone in the gallbladder neck could potentially cause biliary obstruction, leading to severe complications if left untreated.
- Sphincter of Oddi dysfunction: This condition can cause recurrent pancreatitis and is often associated with biliary-type abdominal pain. Although less likely, it is a potentially serious condition that should not be missed.
- Rare diagnoses
- Hypertriglyceridemia-induced pancreatitis: This condition is rare but can cause severe pancreatitis. Although the patient's triglyceride levels are not provided, this diagnosis should be considered if other causes are ruled out.
- Pancreatic divisum: A congenital anomaly of the pancreas that can cause recurrent pancreatitis. Although rare, it is a possible diagnosis in a young patient with acute pancreatitis.