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Gallstone pancreatitis with cholangitis — MCCQE Part 1 MCQ

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HardAbdominal PainGallstone pancreatitis with cholangitisMCCQE Part 1

A 61-year-old woman has acute pancreatitis with fever, jaundice, right upper-quadrant pain and hypotension. Bilirubin is rising and ultrasound shows common bile duct dilation. Which of the following is the most appropriate next step?

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Correct answer: C — Urgent ERCP for suspected acute cholangitis with biliary obstruction

Gallstone pancreatitis plus fever, jaundice and hypotension suggests cholangitis from persistent obstruction, requiring urgent ERCP. Uncomplicated pancreatitis does not need routine ERCP, but cholangitis changes management. Colonoscopy and antacids do not relieve biliary obstruction.

Reference: Canadian acute pancreatitis guideline; Canadian Association of Gastroenterology practice