Differential Diagnosis for Cholelithiasis with Nausea and Elevated Lipase and Amylase

• Single Most Likely Diagnosis

  • Gallstone Pancreatitis: This condition occurs when a gallstone blocks the ampulla of Vater, leading to pancreatitis. The presence of cholelithiasis (gallstones), nausea, and elevated pancreatic enzymes (lipase and amylase) strongly supports this diagnosis, as it is a common cause of acute pancreatitis in patients with gallstones.

• Other Likely Diagnoses

  • Cholecystitis with Secondary Pancreatitis: Inflammation of the gallbladder (cholecystitis) can sometimes lead to pancreatitis, especially if a stone obstructs the common bile duct. The symptoms and lab findings could align with this diagnosis, although it's less directly linked to elevated pancreatic enzymes than gallstone pancreatitis.
  • Biliary Colic with Pancreatic Enzyme Elevation: Biliary colic is pain caused by gallstones. While it primarily causes pain, it can sometimes lead to mild elevations in pancreatic enzymes, especially if there's transient obstruction of the bile or pancreatic ducts.

• Do Not Miss Diagnoses

  • Perforated Gallbladder or Perforated Peptic Ulcer: Although less common, a perforation can lead to severe peritonitis and sepsis. The presence of nausea and abdominal pain could be indicative of such a condition, and it's crucial to rule out perforation due to its high mortality rate if untreated.
  • Ascending Cholangitis: An infection of the bile duct, which can occur with obstruction (e.g., by a gallstone). It's a medical emergency and can present with abdominal pain, fever, and jaundice, alongside elevated liver and pancreatic enzymes.

• Rare Diagnoses

  • Pancreatic Cancer with Obstruction: Although rare, pancreatic cancer can cause obstructive jaundice and pancreatitis if it obstructs the bile or pancreatic ducts. The presence of significant weight loss, persistent pain, or a palpable mass might raise suspicion for this diagnosis.
  • Choledochal Cyst with Pancreatitis: A congenital anomaly of the bile duct that can cause pancreatitis due to obstruction or reflux of bile into the pancreatic duct. It's less common and typically presents in younger patients but should be considered in the differential diagnosis of recurrent pancreatitis.