skip to main content

Severe acute gallstone pancreatitis without cholangitis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGastroenterology and hepatologySevere acute gallstone pancreatitis without cholangitisSCE Acute Medicine

A 49-year-old man is admitted with severe epigastric pain radiating to the back and vomiting. Lipase is 900 U/L, CRP is 220 mg/L at 48 hours, calcium is 2.02 mmol/L and oxygen saturation is 91% on air. Ultrasound shows gallstones but no biliary dilatation. He remains tachycardic despite analgesia. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: E — Supportive care with early severity assessment and interval CT if deterioration or diagnostic uncertainty persists

Severe acute pancreatitis needs aggressive supportive care, oxygen, appropriate fluids, analgesia and repeated severity assessment; CT is most useful after 72 hours or earlier if the diagnosis is uncertain or deterioration occurs. ERCP is indicated for cholangitis or persistent biliary obstruction, not gallstones alone. Prophylactic antibiotics are not recommended for uncomplicated sterile pancreatitis.

Reference: NICE NG104 pancreatitis