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Acute pancreatitis — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsAcute pancreatitisSCE Acute Medicine

A 29-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 epigastric pain radiating to the back with lipase 1800 U/L. 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 supportive care with fluids, analgesia and severity monitoring

The key discriminator is that epigastric pain radiating to the back with lipase 1800 U/L, which makes Give supportive care with fluids, analgesia and severity monitoring the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Give targeted antidote or reversal therapy and Arrange urgent specialist referral 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