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Acute pancreatitis — ABIM Board MCQ

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HardGastroenterology/HepatologyAcute pancreatitisABIM Board

A 46-year-old woman has mild gallstone pancreatitis. After 24 hours of treatment she is improving, bilirubin has fallen from 2.1 to 1.0 mg/dL, ultrasound shows gallstones without duct dilation, and she has no fever or cholangitis. Which management plan is most appropriate?

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Correct answer: D — Provide supportive care and perform cholecystectomy during this admission

The best answer is “Provide supportive care and perform cholecystectomy during this admission”. Urgent ERCP does not benefit gallstone pancreatitis without cholangitis or persistent biliary obstruction. This patient should receive supportive care, early oral nutrition as tolerated and laparoscopic cholecystectomy during the index admission to prevent recurrence. Prophylactic antibiotics, routine parenteral nutrition and delayed or absent definitive biliary treatment are not indicated.

Reference: ACG Guideline: Management of Acute Pancreatitis: https://pubmed.ncbi.nlm.nih.gov/38857482/