MRCP suggested cholecystitis. We consulted surgery – laporoscopic cholectystectomy the next day with confirmation of cholecystitis.

The big clue is the ALT > 150. While not highly sensitive, this is highly specific for gallstone pancreatitis. My 3rd year student found the reference to that clue. I had always thought that the alk phos was the most useful test in this situation – so I learned something.

Even without that clue, the symptoms made us highly suspicious of gallstone pancreatitis. This is the most common cause in the US. I believed his no alcohol history, and found no clues on labs that he was not telling the truth.

h/t to David whose first post he spot on.