Chart — Gastrointestinal
Cholecystitis vs Pancreatitis Chart
Two upper-abdominal emergencies that share a culprit — the gallstone. The pain radiates to opposite places (right shoulder vs straight back), and the labs tell them apart: alk phos and bilirubin point to the gallbladder, lipase to the pancreas.
Educational use only. The two coexist (gallstone pancreatitis) — and labs/imaging confirm. Use the full clinical picture, not one feature. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Feature | Cholecystitis | Pancreatitis |
|---|---|---|
| Pain location | RUQ/epigastric → radiates to RIGHT shoulder/scapula | Epigastric/LUQ → bores straight to the BACK |
| Position | Restless; pain after fatty meals | Eased by leaning forward / knees up; worse supine |
| Hallmark sign | Murphy's sign (inspiratory arrest) | Cullen's (periumbilical) & Grey Turner's (flank) bruising in severe disease |
| Key labs | ↑ alkaline phosphatase, ↑ bilirubin, ↑ WBC | ↑ lipase & amylase, ↓ calcium, ↑ glucose |
| Top causes | Gallstones (5 F's risk profile) | Gallstones and alcohol |
| Diet/management | Low-fat; cholecystectomy ± ERCP | Goal-directed IV fluids, pain control, rest the pancreas; treat the cause |
| Watch for | Obstruction (jaundice, clay stools), gallstone pancreatitis | Shock, ARDS, AKI, hypocalcemia, infected necrosis |
Exam Traps
- ✦RIGHT shoulder radiation + Murphy's = cholecystitis; BACK radiation relieved leaning forward = pancreatitis.
- ✦Lipase points to the pancreas; alk phos and bilirubin point to biliary obstruction.
- ✦Calcium FALLS in pancreatitis (saponification) — not a cholecystitis feature.
- ✦A gallstone can cause BOTH — a CBD stone blocking the pancreatic outflow = gallstone pancreatitis.
- ✦Cullen's/Grey Turner's bruising belongs to severe hemorrhagic pancreatitis.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American College of Gastroenterology (ACG) / AGA · ASPEN (nutrition support). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →