Question

A 45-year-old man presents with sudden severe epigastric pain radiating to the back and vomiting after a weekend of heavy alcohol intake. Serum amylase is 980 U/L (normal <100 U/L). Ultrasound shows a normal gallbladder. What is the most appropriate initial management?

Accepted Answer

Nil by mouth, aggressive IV fluid resuscitation and opioid analgesia

Answer

Immediate ERCP and sphincterotomy

Answer

Start broad-spectrum IV antibiotics for all cases

Answer

Discharge with oral analgesia as serum amylase is not specific

Answer

Start nasogastric feeding immediately and avoid IV fluids

Practice question

A 45-year-old man presents with sudden severe epigastric pain radiating to the back and vomiting after a weekend of heavy alcohol intake. Serum amylase is 980 U/L (normal <100 U/L). Ultrasound shows a normal gallbladder. What is the most appropriate initial management?