MedMigrant

Question 339 · LEK · Acute pancreatitis

A 48-year-old male presents at the Emergency Department due to severe epigastric pain radiating to his back, nausea, and vomiting of food contents. The symptoms persist for a dozen or so hours. In history: cholelithiasis. Physical examination revealed yellow sclera, epigastric tenderness, and no bowel sounds. Laboratory tests revealed elevated inflammatory markers (WBC, CRP), elevated cholestatic markers, and high serum amylase and lipase levels. Abdominal ultrasound revealed gallbladder deposits and dilatation of the common bile duct; the pancreas was visible partially, with inflammatory infiltration. Indicate the appropriate management:

  1. A. only conservative treatment, without any invasive procedures, including hydration, painkillers, and oral nutrition.
  2. B. immediate cholecystectomy, followed by conservative management of acute pancreatitis.
  3. C. urgent endoscopic retrograde cholangiopancreatography with removal of deposits from the common bile duct.
  4. D. immediate initiation of pancreatic enzyme therapy on outpatient basis, without the need for hospital admission.
  5. E. urgent empirical antibiotic therapy (started in the Emergency Department), as in any case of acute pancreatitis.
Hint

This is biliary pancreatitis with signs of ongoing bile duct obstruction; what procedure removes the cause from the duct?

The answer, the explanation and a note on every option are available once you log in. The account is free: topic tests, a mock exam, mistake review and statistics.

Create a free account Log in

More questions on Internal medicine