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Acute pancreatitis — MCCQE Part 1 MCQ

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ModerateAbdominal PainAcute pancreatitisMCCQE Part 1

49-year-old woman with gallstones presents with severe epigastric pain radiating to the back. Lipase is more than three times normal and she is vomiting. Which of the following is the most appropriate next step?

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Correct answer: E — Give IV fluids, analgesia and assess severity and biliary cause

Give IV fluids, analgesia and assess severity and biliary cause is best because typical pain plus elevated lipase confirms acute pancreatitis and initial care is supportive with cause assessment. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Gallstone pancreatitis requires biliary evaluation once the acute episode is stabilised.

Reference: Canadian clinical practice guideline for acute pancreatitis