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Gallstone pancreatitis with ongoing obstruction — SCE Acute Medicine MCQ

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HardAcute GI PresentationsGallstone pancreatitis with ongoing obstructionSCE Acute Medicine

A 50-year-old woman with acute pancreatitis has persistent jaundice and fever 24 hours after admission. Bilirubin is 142 micromol/L, ALP is 510 IU/L and ultrasound shows gallstones with a dilated common bile duct. Blood cultures grow Escherichia coli. What is the most appropriate next step in management?

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Correct answer: E — Arrange urgent ERCP for biliary decompression

Gallstone pancreatitis complicated by cholangitis or persistent biliary obstruction requires urgent ERCP for source control. Falling lipase does not remove the need to treat infected obstruction. Ursodeoxycholic acid is not definitive in this acute setting. The pearl is that ERCP is not routine for every gallstone pancreatitis case; it is targeted to cholangitis or obstruction.

Reference: NICE NG104; BSG pancreatitis guidance