The nurse is caring for a patient with cholelithiasis who has a new laboratory finding of serum amylase of 300 units/L. The patient states, "My primary health care provider said I don't have pancreatitis."

Question

What is the most likely explanation for the laboratory finding? 1. The gallstone is causing acute cholecystitis.
2. The gallstone has migrated to the neck of the pancreas.
3. The gallstone has caused bile to back into the pancreas.
4. The gallstone is blocking the common bile duct.

Answer 1

4
Rationale 1: Acute cholecystitis is not reflected in elevated amylase levels.
Rationale 2: It would be highly unlikely for the gallstone to migrate to the neck of the pancreas.
Rationale 3: The gallstone does not cause bile to back into the pancreas, although it can cause pancreatic enzymes to back up into the pancreas.
Rationale 4: When a gallstone blocks the common bile duct, pancreatic enzymes cannot exit the common bile duct and back up into the pancreas, causing pancreatitis, with elevated pancreatic enzymes. A normal serum amylase level is 0–130 units/L.