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Gallstone pancreatitis with cholangitis — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsGallstone pancreatitis with cholangitisSCE Acute Medicine

A 58-year-old man presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show pancreatitis with fever, jaundice and dilated common bile duct. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give antibiotics and arrange urgent ERCP for biliary drainage

The key discriminator is that pancreatitis with fever, jaundice and dilated common bile duct, which makes Give antibiotics and arrange urgent ERCP for biliary drainage the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Give intravenous fluids with reassessment and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG104; BSG ERCP guidance