The nurse is assisting with the care of a client. For each finding, click to specify if the finding is consistent with small bowel obstruction or acute pancreatitis. Each finding may support more than 1 disease process.

Pain Level: Severe mid-abdominal pain can appear in both small bowel obstruction and acute pancreatitis. SBO typically presents with crampy, colicky pain related to peristaltic waves. Pancreatitis pain is usually epigastric and radiates to the back, but severe abdominal pain alone does not exclude either condition. WBC Count: A WBC of 9,000/mm³ is within normal range but can still be seen early in SBO or pancreatitis. In both disorders, leukocytosis may develop as inflammation or ischemia progresses. Normal WBC does not rule either condition out and is compatible with both at presentation. Lipase Level: The lipase level of 40 units/L is within normal limits, making acute pancreatitis unlikely because pancreatitis almost always shows lipase elevation to ≥3× normal. A normal lipase is expected in small bowel obstruction, as SBO does not directly affect pancreatic enzyme release. Social History: The client drinks 1–2 glasses of wine daily, which is a known chronic risk factor for pancreatitis. Alcohol use does not contribute to small bowel obstruction, which is more related to adhesions, hernias, or tumors. Thus, this finding supports pancreatitis more strongly. Abdominal Findings: Tenderness with high-pitched bowel sounds indicates a hyperactive bowel attempting to push against an obstruction. Such “tinkling” or high-pitched sounds are characteristic of small bowel obstruction and develop as gas and fluid accumulate. Pancreatitis more commonly shows hypoactive or absent bowel sounds with diffuse tenderness. Skin Findings: The absence of jaundice or discoloration is compatible with SBO, which typically does not produce skin changes. Acute pancreatitis may produce ecchymoses (Grey Turner or Cullen signs) or jaundice in biliary involvement, so normal skin findings make pancreatitis less likely.