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Acute Pancreatitis — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineAcute PancreatitisRACP Adult Medicine

A 52-year-old man with a history of alcohol misuse presents with acute pancreatitis. His APACHE II score is 14 and CRP is 280 mg/L at 48 hours. CT at 72 hours shows 40% pancreatic necrosis. On day 10, he develops spiking fevers. What is the most appropriate next step?

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Correct answer: A — CT-guided fine needle aspiration of the necrosis

Development of fever with documented pancreatic necrosis raises concern for infected necrosis. CT-guided FNA with Gram stain and culture is the standard investigation to differentiate sterile from infected necrosis. If infected necrosis is confirmed, a step-up approach is recommended: percutaneous catheter drainage first, escalating to minimally invasive endoscopic or surgical necrosectomy if needed (PANTER trial). Routine prophylactic antibiotics for sterile necrosis are NOT recommended.

Reference: eTG – 2025 – Gastrointestinal; IAP/APA – 2024 – Acute Pancreatitis Guidelines