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Severe gallstone pancreatitis — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologySevere gallstone pancreatitisSCE Acute Medicine

A 54-year-old woman has severe gallstone pancreatitis with persistent respiratory failure at 48 hours. Bilirubin is 18 micromol/L, ALT is falling and ultrasound shows no duct dilatation or cholangitis. Which plan is most appropriate?

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

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Correct answer: B — Supportive care, early enteral feeding and cholecystectomy after recovery

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

C is correct. Severe acute pancreatitis requires high-dependency or critical-care support and enteral nutrition begun within 72 hours where feasible. In gallstone pancreatitis without cholangitis or persistent common-duct obstruction, urgent ERCP offers no benefit. Prophylactic antibiotics are not recommended without infected necrosis or another infection. Unlike mild gallstone pancreatitis, cholecystectomy is deferred until the severe inflammatory episode and collections have resolved. Routine parenteral nutrition is used only when enteral feeding fails or is contraindicated.

Reference: https://www.nice.org.uk/guidance/ng104/chapter/Recommendations