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Gastroenterology — UKMLA MCQ

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HardGastroenterologyUKMLAMRCEM SBAMRCP Part 1

A patient with chronic pancreatitis develops tense ascites. Serum albumin is 34 g/L and ascitic albumin 25 g/L. Which additional ascitic-fluid profile most strongly supports pancreatic duct disruption?

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Correct answer: B — Amylase 4200 U/L and protein 38 g/L

The best answer is “Amylase 4200 U/L and protein 38 g/L”. The serum–ascites albumin gradient is 9 g/L, or 0.9 g/dL, which is below the portal-hypertension threshold. Pancreatic ascites from duct disruption or a leaking pseudocyst characteristically contains very high amylase, usually above 1000 U/L, and high protein above 30 g/L. Chylous ascites has raised triglyceride, spontaneous bacterial peritonitis has neutrophilia, and malignant cytology suggests a different exudative cause. The biochemical combination directs pancreatic duct imaging and specialist therapy.

Reference: Pancreatic ascites: diagnosis and management review: https://pmc.ncbi.nlm.nih.gov/articles/PMC12070342/